HomeMy WebLinkAbout2534 Form E. T. C-601-D-(~OM--7•10-b8) ~1- 0(~
Declorotion of Domicile and Citizenshi
P
TO THE STATE AND COUNTY ~A% ASSESSOR, :.[l~s~~~
.S 7': L.•~ c% c. (~OUNTY. FLORIDA:
Thia ia my declaration oi Domicile and Citizenship in the State of Florida that I am flling thia dmy in
aocordance, and in conformity with Chapter 22, Section 222.17, Florida 3tatutes.
I waa formerly a legal reaident of_~ r!~' x_ •
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snd I reaided a~-- .3.t---- /~/e~ o.~s. t C 7+'; However. I have chang~ed my domicile
( Street and Number)
to and am and have been a bona flde resident of the State of Florida since_____________ 3! ____~._.day oi
MQ~.-----__~_~, 19~~, and I reside at___~-~ SOi~~ -
(Street and Nnmbet)
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and thia atatement is to be taken a$ my declaration of citizen~hip, actual legal residence and domicile in
the State of Florida.
(Inaert here any pertinent faeta. auch as sale oi~ prnperly or buaineu, or relinqniahment oi emnloymeat at
former domicile. removal oi lamil~ to asw domicile. parcbsse oi hom~. ete.)
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FII.ED AND RECORG D .
ST. LUCIE CfJUNTY~•~,p,`
RECORD VERIFIEO
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'~6 J(!~~ Z PM 3:00
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~a~~K 'OITRAS
CLERK CIRCUIT COURT
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I I~LJR.THE~t CERTIFY that I will reg?ister at my local address when the registration booke reopen,
and comply ~vith all other requirementa of a legal resident of tlus 3tate.
I FiJBTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
; • T f c ~c ~ /g~ e v4 .~g~------ _ County Florida
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~n.~~~nd si~~sepbgd before me tbis_:
~1__day of RFD ~~'~C-/pC~ CUS IQT SO,
` " ' ' F L ~ ~ ~ I A. D. 19~~.. ~ •
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Poblie ~Rlb~d~
~ ~ . Mr co~WlSS~~N ~~owas er te~~
~ M~r Co~misaion e:pires_~~__
~~ES EE~ _
? (To be ezeented in d~tPlio~te u~ o~[~a1 S1ed wkh C1eri~ Cirenft Co~ ~od duplieste witb Taz Aa~awr)
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; - o R 147 ~ ~32
BOOK
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