HomeMy WebLinkAbout2323 Declaration ot Don~icile and Citizenship ~
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i0 TNE STATE AN~ COUNTY TAX ASSESSOR,
Sl LUCIE COUNTY, fIORIDA ~
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Th~s ~s niy ~eclarahon ot Do~n~c~le and C~hzensh~p in the State of Flonda that I am fil~ng this day in accordance and
~n conformiry with Chapter 222, Section 222.17, Florida Statutes
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Y 9 ' 1''~' ~~~'~C" ~L j ~~~~i/-~~r ,~G~ ~ i
i was formeri a le al resident of
(City) (State)
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and I resided at ~ _i~ ~ However 1 have changed my domiule
~ (Street and Number}
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~o and arn and have ~een a bona fide resident of the State of Florida since , day of
J
, 19 , and I ~eside at
~
6 ~
~ (Street an Number)
t FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
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~nd th~s statement ~s io be taken as my dedarat~on of c~tizenship, actual legat residence and domicile in the State of Florida.
_ (Insert here any pertinent facts, such as sale of property or business, or relinquishment of employmgnt
' at former domiciie, removal of family to new domicile, purchase of home, etc.) `
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_ ~~~.'~C ~~...e~ ~C~~jl, ~~t FtlEO AN~ RECOA EO ~
a ~ ST. WCIE COUNTY ~LA.
- ROGER FOITqAE
- Ct ERK C~~CUIT COURT ~
RECORG VERtFfE~~
~i
~10Y Z IO 12 ak'7 ~
. 218020
I FURT~IER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently t NRA~m A. SALISBuRy ~
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; Z'~Ll~h - .f~
_t~~t ~ . '
Name ~ ~ - ~
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_ _ _ t
(Address) ~
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~wom to and subscr~bed before me Sh~s _ day of _ 'y ~ ~ b e tr- _ . _ _ _ , 19__1_! '
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ROGER. POi~RrAS , " _ _ _ - - - - - - -
- - CLERK,CIRCUIT COURT Notary Publ~c
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' By _ ~ _ _ ~ ~'~~~_t _ D.C. My Commission expires
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(To b~ ~x~cuMd in duplicate and original filed with Cltrk Circuit Court, and duplicat~ with Tax Ass~ssor.)
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