HomeMy WebLinkAbout2690 Decl~ra~ti~n ot Damicit~ Cii:zes,~:::,~
IJ TnE STAT't A~;D COUti~Y TAX AJ~EJ~On.
218~93
~i. Li:~.iE COUNTY, F;ORiDA
Tn,s ~s my ae:~arot.on ut Domec~+e an~ Gtizer,snip ~n th~ ~:ate o~ F~~rida that , am f~t~n~ this day in accordance and
n con:orm;ty w~th Chapter 222, ~ect~on 222.17, Fiorida Siatutes.
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i was tormerly a ieyal res~dent of .--~~C~ - -
(City} (State)
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ana 1 res~ded at __~U~~_ ~4~k,~E__ _ However I have changed my domi~i~e
(Street and (vumbery
~o and am and have been a bona f~de resident of the State of F~or~da s~nce _ I~day of
- - - _ , 19_. . , and i reside at _~SX~~~T _ _ '
(Street and Numbarj
FORT PIERCE, SAI~I? LU~IE COUNTY, FIORIDA
an~ tn;s statement ~s to be taken as my dec;a; ation of cisizensh~p, ac:uat ~e^yal resi~ence anci dom;tiie ,n tne Stote of "r:orida.
~Insert here ar.y pertir.ent facts, such as sale of proper;y or ous~ness, or ~el;^qu6shmen! of emp{oyment
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at former dom;c+;e, removal oi famiiy to new domic~:e, purc::ose of home, etcJ
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~ - ~NO REC01~~E~ ~
f I t0 ~E ~aONT`I , t' ~
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~oc~R po~t~~s ~1~
y RECORO YEpIf1E0 cOY..+~~ ,
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218293
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- i FUR7;iER CEKTiFY that I w~ll comply with al! other reau;remen:s of a fega! :esi~ant o` r~is Stase.
I"ruRTn~R C~R~~FY tnat 1 have no inter;ion to retum to'm,y iorme: doms~::e, ar.d i,r.terd to remain i~ FORT
- "r,~e~C" SAIPi~ L'JC+"t CGuN;Y, FLORiDA, permanentiy.
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- Sworn to and subscr.oed :,efore me th:s day oi , 19_____~.
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ROGER pOtTRAS ~ - - - - _ _ -
CLERK CtRC~jIT COURT No;ary ?u:,:ic
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B ` ' ~.C. t.:~ Com
- ' ` / .;.':•~s;on exp ~es
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_ (To be ozocuted in duplicase -and oric~inal filed with Uerk Circuit Court, ~nd d~plicase wit~ T~x As:.:s:o:.)
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