HomeMy WebLinkAbout0058 ~ ~
Declaration ot Dar:~icite anai ~.izi~ensi~i~
70 THE STATE Ai~D l:OUNTY TAX ASSc550R, .
~i. lUClE COUNTY, FIORlDA: 2185 I`~
Th~s ~s my declaration of Dom~u?e and Citizensh:p i~ the State of Florida that 1 am filing this day in accordance and
~n conformiry w~th Chapter 222, Scct~on 222.17, Fiorida Statutes.
! was formerly a legal resident of ~ XL~~.4 w~ ~ y1'~'~
(City) (State)
~
i
and 1 resided at ~if1_ ~r _ _ _ _ _ However 1 have changed my domicjie
(Street and Number)
~o and am and have been a bona fide resident of the State of Fiorida since _ - day of
G~o~ e r___ ~91~, and I reside at __~~-1~~~~e r Q
(Street and Number)
FORT PIERCE, SAIN? lUC1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizensh~p, actua~ +e5af residence and domicile in the State of Florida.
(Insert here any pe:tinent fatts, such as sala of proper;y or business, or re{ir.quishmenf of employment ;
~
at former domic~~e. removal of famiiy to new domicile, purchase of home, eJc.)
i
~
i \ _
i p ~
~ f ILEO AND R~N~Y ~
~A. u i
~ st.wc~c cou
~ a~c~ tiRCU ~ CO Rt ~ ,
~ CIEa YEa~f ~EO
~ RECOaO
~ y~~ ~OS2~~1~
~ ~
~
~ ~
~ 2155'74
: r
;
i
~ ~
~
~
s .
~
~
~
i
~
i I FURTHER CERTIFY that I wii) comply with all other requirements of a legal residerst of this State.
~
~ I FuR i HER CERTIFY that 1 h~: .~;ent+on to return to 'my former domic,ile, and 1 inter,o to rernain in rORT
h ~i.RCE, SAIN7 LUClE COUNiY, FLORIDA, permanent{y. i
.
- ~~~-~/Ll~~~~ a ..vt-~i !i`1~
(Name)
.
_ ~1/ A~~' .L n~1-z~e
= (Address;
'Y
y Sworn :to e~d. subscr~bed before me th~s - y 9~.
l da of ~~t~1~~1=_~~
~
RQGER PORRAS
CIERK GRtU1T~~t1 hotary Pu~iic -
• _
' ~ ~ ~
s ~ ~ / •~'LL" ' D.C. My Commission exoires _
(7o be oxecuted in duplicate and original filcd with Clerk Circuit Court, and duplicato with 7ax Ass~;s~r.j =
- aooK 1~ r ~~~t
- ~ W
t,. -