HomeMy WebLinkAbout2051 Deciaration of Domicile and Citi~enship ~ _ ~
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'['O THE ST'AT~ AN[~ COUNTY TAX ASSESSOR,
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-~~~-~-t-t-i1___ COUNTY, FLORIDA:
Ti~is i~ tny drelaralion uf Don~icile acid Citizensllip in th~ State oF Florida that 1 am tiling this day in
acc~r~.~ncc, and in contormity with Sertic~n ~~?.17, Florida Statutrs.
1 was formerly a legal resident ot' , and 1
~c~ ~ ~r~
resided at _~~'c~-~~-_---__-_--_-_---- However. I have changed my domirile ta
(Strret and Numbrr)
and am and have becn a bona fide nrsidrnt of the St:~te of Florida since _____'3O _ day of
-~i~,r. < n.s 19 7,~_. and I residr at ~l //~3 j~
~ ~ (Street and Number)
~i4_Le • e~~~...~_ COUIIty, F~OTld3,
(City) '
arzc! fhis statement is to be taken <~s ~ny dcrlaration of citizenship, actual legal residence and domicile in the St;~te
of Florida.
(Inseri Aerr any prrtinent facts, surh as s;~le ot proprrty or business, or ~elinquithment of employment at tormar
domicile, remo~~al of family to nrw domiciir, purchase of home, rtc.)
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i11E0 ANC RECORpEO
ST. LUCIE ;,4UMTY FU.
~ AecE~- ~~~tR~?s
CLERx L~~,CUI~ C4URT
REC~JR^ Y£~tf1E0.~,~..~...
fEe 1 4 4a PH'Z3
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, I FURTHER CERTIFY th.it t will re~~ist~r at my lorai address wh~n the registration books reo~en, ~na
comply with ail other requirements of~ a le~al resident c~f this State.
I FURTHER CERTIFY that ! ha~~~ nc> intenti~~n to return to my fornier domicile, and 1 intend to rem~iin in
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j . L ' ~ = (Addre~.1)
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"SWdru t~~ah~~ubscribed be1'ore m~ ihis°'~ e1a~~ of
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~t CLc~
- - -o - - ~c State of Floridr at Large - - - - - - -
My Commission expires ~ _S- 7~_
(To be exrcutrd in dupli.atr anJ ong~nrl filyd ~vith C'Irrk Citcuit Court. and duplicate with Tax Asseswr)
~ooK 210 20~~
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