HomeMy WebLinkAbout2109 Decfaration of Domicile and Citizenship
TO THl: STATt: AND ('UUNTY TAX ASSk:SSOR,
~G1%y_ _ --u-~tcCi COUNTY, FLORIDA:
Ti~is is my Jrclaration of Uomiril~ and Citi•r.rnship in th~ Statc of Florida that 1 am filing this day in
acrordancc, and in contonnity wiNi Section „_'.17, Florida Statutcs.
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I wus I'om~rrly a legal reside~~t ot= u and 1
(C y) • (State)
rrsided at - . ~~~'-~4-~! ~ . Howrver, 1 have changed my domicile to
(Strret anJ humbrr) - /
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and am and ha~~°e br~n a bona tide resident ot~ the Statr of Florida since day of
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~ G`7i`P%ntZ~ 19~L_. altd I rrside a[ _'2_ 9.C ~__~GC.~~`~~~
(Street and Number)
/~..t~U , County, Florida,
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and this statem~nt is to be taken ;~s my declaration of citirenship, actual legal residence and domicile in the State
oi' Florida.
(insrr~ hrrr any prrtinrnt facts, wch as ~Ir ot ptuprtty or Ausinru, or relinyuishmrnt of employmrnt at tormer
domicile, rrmovai of family to neN• d~~micilr, purchasr of home, etr.)
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243050
fILEO AMU REGOROEO
ST. LUCIE COUNTY FU.
ROCE~i POITRAS
CIERK C~~CUIT COURT
RECOR~7 vER•r~~p~_
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1 FURTHER CERTIFY th.~i 1 will registcr at my- loral address when the rc~.is..ation books reopen, and
~omply with all othcr reqt?irements of a leg~l rrsident of this State.
I FURTHER ERTIFY that I h~?~~c no intention to mturn to my forn~er domicile, and l intend to remain in
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~ $t~c'or~~.t • lj~d+s~fiscribed before me this ~la~• of
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- - - - - A. D. 19 ~_'7'.
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~ otarv Public State lorida at Laree
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° Aty Commission e~pires ~ /s ~y7~O . ~
(To be r~rcuted in duplicate and uriKinal filed with ('IerA Circuit Court. and duplicate with Tax Assessor)
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