HomeMy WebLinkAbout2851 D.:cla~ a~eon ot ~oriiicite an~ C~t:~~na~~i~
f0 THE STATE AhD COUhTY TAX AJSEaSOR,
~i. IUCiE COUN7Y, F10~21DA: ~8415
Tn~s ~s my deCiardhOn Of DJm~Ci~~ and Gtizensn~p in the Stare of Fiorida that 1 am fil~ng th;s day in accordance and
,n conform~ty w~th Chapt~~r 222, Sect~on 222.17, Florida Statutes.
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1 was formerly a legal resident of - -
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. ~C;ty~ (State
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and 1 res;detl at -1-- - ~'t ~ ~ f ~ - - _ However I have changed my domi~iie
(Straet and Num~ber)
'o and am ana have been a bona fide resident of the State of fiorida since oay of
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' , ~C ~ / ' . y/ 3 . ~z ~ .t C~;'~t L< <
~---'--i - _ . _ . - - 19_-- - , ana t reside as -
~ ;;,t:~et and Nurnb~ ~
FORT PIERCE, SAIyT LUCIE COUNTY, FLORIDA ~ ~ ~ ~ ~I f ~ - ~ ~ / C C C
; and tnis statement ~s to be saken as my dedaration of cisizensh~p, actuai iega~ res~cence and domic~fe in tne State of Fiorida.
~ (Insert he~e any pert~nent facts, such as saie of property or business, or rei,r•,_ .:zmer.t of emp;oyment
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; at formzr domiciie, removal of fami~y to new domicile, purchase of nome, etc.) ,
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~ 218415
fllE~ AND P.fGOR0E0
ST. IUCtE COUNrY fLA.
- CIERK CIr~CU1T COIfRt
- RECORD YER~F~EO.~,~
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I FURTHER CER7IFY that I wi11 comply with ai{ otner requirements of a leral residen; of th;s Siaie.
_ t FURTriER CERTIFY that ( have no i~tent~on to resurn to 'my former domiGle, and 1~n;end to remain in FORT
?IcRCE, SAINT LUCIE COU~ITY, FLORiDA, permanentiy. '
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(Name) . '
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Swom to and subsu~bed before me this t/ day of r"'_`_ , 19 ~J
= = RCGER P017RAS -
~ G4ERK CIRCUIT COURT Not3ry Pub~ic
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5y D.C. My Commission exQi:es
- (7o be exocuted in duplicate and origina) filsd with Clerk Circuit Court, and duplicato with Tax Assc:.::.:.)
800~196 ~~E284? ~
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