HomeMy WebLinkAbout1693 Deciaration of Domicile and Citizenship
TO THL STAT ~ ANU C OUNTY TAX ASSt~SSOR. ~2~45
f~~t~ - COUNTY, FLORII)A:
c..~~~T • `
Tltis is n~y clrclaratiun ol~ Uomiriic and Citizcnship in th~ State ot Florida that 1 am ~ling this day in
accor~iuncr, and in conformity with Sertion '_".17, Florida Statutes.
1 was formrrly a legal residcnt of -_--_----~1_~_/~TO~------,----_- and 1
~ (Ci~r) , (sata)
n:siacJ at ~
Z- .~!'"1_1~L~ _,~!"y However, 1 have changed my domicile to °
(Street a~J Numbrr) ;
~nd am aitd have bern a hona lidc nsident of the State of Florida since~~U day of `
i
~,,l ~
. 19~Z . and I residc at ~~0~~l-- 6"~-~
_ ~
G ` (Street and Numbcr)
_~~1 _f ? _ c N C._- ~ ~v ~ ~ ~ County. Ftorida,
tc~~r)
and this statement is to be taken as my declaration ot citizenship, actual legal residence and domicile in the State
of Florida.
(lnseti here any peitinrnt facts, such as sale of property or businrss, or rrlinyuishment of employment at former
domicile, remo~al uf family to ~rw domicile, purchase of home, rtc.)
.
~~t'~Cf[ ~Ll~
~
~
FIlEO AM~ RECORaEO
ST. LUCIE ~8L'MTIf f1.A.
~ ROGEF i ~)ITRAS 1/~
CLE~X Ct~.Lsi1T COUR1 C
RfCQRn Y~~ c~rQ~
!
' ' ~ MOY Y8 ~ 54 PM'~Z
J -
242'~4S
;
1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and ~
comply with a11 other requirements of a legal resident of this State. i
~
I~ I FURTHER CERT(FY that t have no intention to return to my former domicile, and I intend to remain in s
~1---~f~_~ ~ L' / ` County,
Florida, ~erm~ne~i~Uy.
,`~a~~~~ u~,,,,~~.
J~ •~!C
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\j G ~/~1~ : V !i~~%~=`-'~'" K_ v~~.i"'~'"" ~-'IiIG'r/
- ~.'V~'~~ __-li~ (Name)
_ '_Noz.-;~ ~ ~ e d .co~.~
- • y, .
' • a ;
i Ln ~ ~A r~~ y.} -
_ ~f~ LB L~~!'~r: = (Addressl
- c•` ' ~
~1~.~
~"S~~h.tq~;wel' b~vzibed before me ihis clay of
~ : /
, _ c.~~?~
~'t C~c~Lt-c c~- 4. U. 19~~---"
,
c ril,~t_
/ N ry Puhlic State of Florida at Lar
Mv EpMea~SSWN EXP~KtS i. 3,~1973
ti9y Commission expires-, _ ~ iMMI iR~ WES~F7~
(Tu be c~rcutrd in duplicatr and ~~riginal titrd w-ith Clerk Circuii Court, and duplicate with Tax Assessot)
t
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