HomeMy WebLinkAbout4773 ~'-~4~U0
Declaratian of Domicile and Citizenship
TU THt: STATL' ANU COUNTY TAX ASSI::SSOR,
~t. I,ucie ~-UUNTY, FLORIDA:
Tiiis is my drel.uation oi' Uomicile ~nd CiUrenship in the State af Florida that I am fiting this day in
accordance, and in conformity with Section ?'?.17, Florida Statutes.
1 w~s formerly a Icg~! resideni oi' ---Aow ie - • - rvl8nd ~nd 1
(City) (State)
r~sidcd at _______1.~315___'~=ika _ I,~r.e _ Ho~~cver, I havc changed my domicile to
(Strrel and Numbrr)
and ;~m and have be~n a bona tide residrnt ot~ the St~te of Florida since lst _ day oi'
___~ecember------__ . 19_ and 1 reside ac 1~9~_~Q~C `_Y~~
(Strert and Number)
Ft. Pierce St. Lacie
- County. Florida,
(c~~y)
and U~is statement is to be taken as my declaration ot' citizenship, actual legal residence an;: domicile in the State
of Florida.
(inser~ here any prrtinrnt facts, such ac saie of pruprrty or businrss, ur relinquishmrnt ot employment at former
domicitr, rcmo.ai of famiiy to new domicile, purchas~ of h~mr, rtc.)
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~ iT~iu°ciE couMir ~i~°.
C~ RKCC RCtlIT C UAt
Eatablis} in~ residence RECORp VEAtF1E0.~.,,,,,,,
Enterin~ children in school ~ 3 i0 2(~'13
~
9th ~rade ~ ~pd''l
3rd and 4th grzdea
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; 1 FURTHER CERTIFY that I wiit reRister at I11V toca! address «•h~n the rrgistration books reopen, and
rom~~ly with alt other requirements o( a legal reside~~t of this St:~te_
` 1 FURTHER CI:RTIFY that 1 ha~~r nu intrntion to reti~rn to my former domicile, and I intend to rrmain in
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E ~'t L P~erS~_ - - - ---.~~.--I?LiC~e---~---- C~ounty.
~ Florida. permanently. ~r~~~? - - -
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~=qrt~ to atxj tit+~cribcd brfor~ me chi~ 3rd _ clay of
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- ---slaritlary_ A.D. 19 7~
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NotarY Public Statr ~+f Flurida at Lar~;c
~1y Commission expires _ t~ /S - ~
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' NOTAf~1T`~~ll~r`1 ~~t~of~~`~~',~~ ut~~inal filyd «ilh l'Irrk l'ircurt l'~~urt, and dupl~ratr ~+ilh Ta~ A,csecu~r)
MY COMr?ti~ss~e~v tY; :~:s ~w~v. i~, i. _
BONDFO 1HRU GE',F 1.. E 0~~?~ zU~~ I~
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