HomeMy WebLinkAbout2002 ~~:C:I~Ya::::C7i1 Ot F~'JCi7iCS?e u: ~'viiti~ai,:>.::;~
21'7812
~ ; O~TnE ~STATE :atiD i.U:i\ : Y iAX ASSE~OR.
ji. IUCiE COUNTY, rlORl'JA
Th~s ~s :7iy ueciara;;un of ~om~ciie and C~i~ze:~sh~p ~n tha 5ta:e of Flor.~a that t om f~i~ng th;s doy ,n accordance and
,n conformity w~th Chapter 222, Sect;on 222.17, F~orida Statu:es.
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~ was formeny o IegaL res;dPnt of ! v ~ ~ _ - - - - - ~ ~a-- ~C!.
(C~ty) (Jtata)
ano I resided ar S
U_ _~51~ ti_Q_ ~ ~ Q~ ~~~~°-E~ However I have changed my domiCile
(Street and Number)
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and am ancf have oeen a bona fide res+dent of the $tate of fiorida since _ ~ 5. _ day of
~ ~
_ 19__ l t. and 4 reside at -
; _ (Street and Numoer)
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FORT QlERCE, SAIN? IUCiE COUNTY, FLORiDA
a and inis stasement is to be taken as my declaration or criza~ship, act~ai ~egal res~dence and domicile ~n the Siate of Florida.
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~ (tnsert here any pertir,ent racts, such as saie of property or business, or re~irquishment of employment
F ai forme~ domiciie, removai of fami~y to new domic;le, purchase of nome, escJ
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z-~: 21'7812
fIlEO ANO IIEC~RQE~
~Y iT. RdCER POITIIAS
CLERII CIRCUtT OOURT
RECORO VERIFIEO.........~.
OCT Z~ 2 21 PM'~ ~~i
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I FURjHET CER7IFY that 1 wi~l comply with a;~ o;~~~: req~irerna~ts of a leya! residant o~ ih;s Ssose.
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I FJRTHER CER7iFY that I nave no inien:~on to retum to ~my former domiCiie, and I inter.d to remain in FOR7
~':."-.RCE, SAli~1T LUCIE CG:iNTY, FLORiC~A, permanently. ~ ,1
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7 E NN,,tame)
y G RrEN
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3 c~,~c,~„t~.,... C~- -
_ (Acdressi
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_ ~ , ~ C ~ ! ~t.~ti ry/
Swom to anG subsu~bed 'oe~ore me th~, day of _ , 19
- ROGER ?OIiRAS
~L~r2K GR ~T COU2T f~;o:~ry P.:biic
- ~ ~t-c-~.L.~_ .~c.G.~~ c7.C. h',y Com :~~ission exp;res
(7o be exewted in duplicato and or~flinal fi{ed witfi Ctork Circvit Cours, and duplicato with 7ax Ass~ssor.} ~
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