HomeMy WebLinkAbout2719 ~ .
De i t' n~ . 24~4
c ara ~o a Dorn~c~le and C~tizensh~p
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE
- COUNTY, FI.ORlDA:
71~is is my cleclaration of Donticile and Citizcnship in the State of Floriu~ ~'.~:st ! asn tuing this day in
acconlanc:~, and in conforniity with Stction 222.17, Florida Statutrs.
1 was formerly a Icgal r~~sident af ~ ~'~1~~dr and [ `
• (City) {S te) ~
rnsided at ~~g~~
`~!v~S~ . However. 1 h~ve changed my domicile to
(Streetfand Number) ~ ~/.~,y~
and am and have bc•en a bofta fi~le rcsidrnt of the State of Florida since day ot
P T'-+!' So/
M
~ , 19~ 3 , and 1 resicie at -~OD D ~ ~ ~ ~ ~
. . ( tteet and IYum~be
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--T.,.~2c~.t. ~ -C~,~orid.,,
(cit y ) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence anc! domieile in the State ~
of Florida.
;
(Inxti here any ~+rrlinrnt facls, such u salr ot.pn~petty or businrst, c?r telenquishment of employment at former `
dumicJe, removal of lamily to nevr domicile, p~rchue of home, rte.) '
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1 FURTHER CERTIFY that 1 will re~istet at my loc:al address when the registration books reo~en, and
i comply with all other requirements of a leg~l resident of this State_
~
~ [ FURTHER CERTIFY that t have no intention to return to my former domicile, and 1 intend to remain in
~
P~- ,a-~- ~ k~ _ . ~~-s~- ~
' C'ounty-
Florida, ~ermanent)y. «"s~~
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- - EV yn 1Na~+0ote - -
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(Address) ~ ~
~
Sworn to and subscribed bePorc me this da~ of ~1 lE~ ~ti~ rykCJ~i~~~
fT.lUt~% fr~GMTr E~~,
~~s~`'" ~ A.D. 19 .7 s . . _ w ROGr - ::,~;Rp~t
- ~ 1iLEQR ~•~.~V~~ aiQ R~
y~ ~ . , ~ • O~f~R~t vct-~r.f0
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Notary Public State " _ _ ~ ~Q p"
~ i~2 6 : A `
i ca.vTy ~JiPCi.~vc: ~.c~ - o rn
4iy Commission expires~~~y~~~« a=~~" - " .
(To bt exeeuted in duplicate and <uiginal filyd with C'etk Circuit CouFY,'?hd duplicate with Tax As:essor)
aoox 2~1 P~ 271?
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