HomeMy WebLinkAbout2962 #
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~ 19e~i~~~tlon ot Damicile ~nd Cittzenship s
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TO TH~ STATE AND COUNTY TAX ASSESSOR, #
S'f , IUCIE COUNTY~ FlC)ltiDA: ~
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' This is my decla~ation of Domicile and Citizanship in the State of Florida that I em flling this day In ecoo~dance and ;
~ in conformity with Cfiapte~ 222, Section 222.17, Floeida Statutes. ~
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$ Columbiz ' Missi~s'~~n~ '
~ I was forme~l a I nl resident of ~
y ~ (State)
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' ?19 Church Street '
` ' end i rosided at . Fiawever I have changed my damidle +
(Streat and Number) . ~
' to and am and have been a bona fida resident of the State of Florlda since 11 day of
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!i ° September 64 Route 2 Box 3500A, Lakcwood ark ~
, 19 , and I reside at
(Street and Number) i
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~ r4RT ~IERCE, SAINT lUC1E COUNTY, FLOR{DA .
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and 4his statemant is to be taken as my declaration of citizenship, actual legat residence and domidle in ihe State of Ho~ida.
(Insert here any pertine~t facts, such as sale of property or businesa, or relinqui:hment af ampldyment ~
et former domitile, removal of family to new domicile; ps~rchase of home, etc.) _ ~ ~
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~ g, ~ FitED AND RECO~
! ~stab.lish ~n re§idence O~D
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- ~ ~ 196~ JAN L .
. '4 AM 10: 5S
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f PoirRas
. - - CDUNjr. F~OR~K
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- 1 F~IRTHER CERTIFY that i wil) oompiy ~rith al) other ~equlroments of a(e~a) rsaldant o~ t~Siy~St~~ts. ' ~
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i~ i FURTHER CERTIFY that i fiave no intention to return to my former domi~ile, and i intend to ramaln in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. . ;
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_ " `..~•'••~1T . (Nnme)
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' ~ . ' : . ~~it~~bc~ua~x Alonzo . Be~r - `
g * ai, ' ' . X , (Address) ~
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. y~~~i~{/£~r~~.tQ~end subst~ibed befcie me this 4 day of Ta~a rv
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~ - • ROl~E~ ~OlTRAS -
~i LERK CI UIT C~URT No*ary Public
F i1 l
r` gy ~ D.C. My Commi:sion expires
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(To b~ ~x~cutsd in d~plicah snd or6~inai fll~d vritl~ Cl~ric Grar~t Couh, a~d dupiieah witl~ Tax A~oea
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