HomeMy WebLinkAbout0233 Dectaration of Domicile and Citizenship
2458'7'7
"I'O THL•: STATt: ANU ('OUNTY TAX ASSESSOR,
_ ('UUNTY, ~LORiI)A:
This is my drelaration oi' Uomicilr and Citizcnship in the Statc oi' Florida that I am tiling this day in
accord:~nr~, and in conformity with Sertion ~,'.17, Florida Statutcs.
t was fornterl le .~I r~sident of Q-~-u_-_--_---_-_-- ~
Y a g• o~`~G ~~c~ and 1
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r~s~~ted ai -Y_r~~~~ . Howrver, I have changed my domiciie to
(Strert and Numbrr~
~nd am and hav~ brcn bona tide residrnt of tlie tate of Hlorida since day at'
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- 1 ) ~ and I r~sid~ at ~ - - ~'md-~'
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-Y-- _
_ _ (Street and Numbe~)
~u't'~ - • - County. Florida,
- - - - ,
tcu,~ ~
c,nd this statement is to be takcn as my declaration of citizenship, actual legal residence and domicile in the State
ut~ Florida. ~
(Insrri hera any pertinrnt f~cts, such ~~le uf pruperty or businrss, or rrlioyuishmrnt of employmrnt at furmrr
Jomicilr, rrmoval nf famitY to nr~a~ domicite, purchase of home. etc.)
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2458`7`7
FilEO A!i0 RECORDEO ~
ST_ LUCiE COUNTY FlA. t
RO.SEa °Q17RAS ;
CLERK C~<<CUIT COURT ~
R;GORD YEA1f1E0~~.• ;
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,l~w 11 I k~ PM'73^ 1~,~" ~
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1 FURTHER CERTIFY that I will re~_istrr at my ioral addr~ss whcn thr r~gistration hooks reoperi, and i
romply with all other requirements of legal r~sid~nt ~f tt~is State. -
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( FURTHER CERTIFY that ! ha~~c nc> int~ ntion to return to my former domirile, and I intcnd to rcmain in
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- -,I _.t~'it~GC~ _ _ _ . _ _ . _~''GL~-c.-L - , County.
Florida,.~ermanrntly. ~~~'t` ~
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Swor~t to an ~iibscribed before m~ thi. ~lci~~ ~f
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Q/~'c - • A. D. l ~)~.3
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tarv Puhlic Statr uf F riJa at I arcr _
~ty Commission expires .-1' ~`~'t~ ~S
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(Tu Fx rrrcuteJ in duphiate and i,nein~l filyd ~vith ('Irrk ('~rcuit Court. and Jupliratr ~~ith Tax Assessori
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