HomeMy WebLinkAbout0206 Dec~aretion of Domicile and Citizenship ,
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TO THE STATE AND COUNTY TAX ASSESSOR,
~ St. Lucie COUNTY, FLORIDA:
'Ihis is my declaration of Domicile and Citizenship in the State of Florida that ! am fling this day in
accordanc,~e, and in conformity with Section 222.17, Florida Statutes..
I was formeriy a legal resident of _ Ashcamp Pike Co. Kentucky and I
,
(City) (State)
resided at Rural District . However, I have changed my domicile to ~
(Stteet snd NumAer)
and am and have been a bona fide resident of the State~ of Florida since day of
January 9 S_
8, and I r~side at 5500 South Federal Highway
(Street and Number)
Ft. Pierce , St. Lucie County, Florida,
_ (Citr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
pnsett hete any pettineat fscts, such ss ssle of property or businas, or relinquishment ot emplormeat at former
domiale; removal ot family to aew domicile, purchase ot Aome, etc.)
~ I am the mother of Pamela Jo Francisco, age 20, who is
applying for the Adrian M. Sample Scholarship. She is
a permanent resident of St. Lucie County and is registered
to vote in said county. She is presently enrolled at the
Indian Ri.ver C7ommunity Colleqe in Ft. Pierce. She resides
with me and her father at the above address.
RbQER
P~OITI{A~ .
OLERt CIRCWT CBtMT
~ RECORC YERIFlEO~.....~.
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other reqiiirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend t~ remain in
Ft. Pierce St. Lucie County,
(cirr) '
Florid~~e~nanently. -
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`~f,~rA6A~~~ut'~ avbscribed before me this ~ da of
lr?srrrn»+~ ~t Y
A. D. 1 ~
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Notarr PubUc Stg ot Florids at Luse
My Commission exp' ~ 9 ~
(To bc e:uuted in duplicate and oriainal t~icd with Clerk Circuit Court. and duplicate witA Tat Assesso~)
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