HomeMy WebLinkAbout1552 -r
~~5251
Declar~tion of Domic~le and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
~ ~C 1 E COUNTY,,FLORIDA:
- 'Il?is is my deciaration of Domicile and Citizensnip in the State of Florida that I am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
I was formerly a legal resident of ~RT ~I~IAI~T~SIv , Y and 1
(Citr) (State)
resided at ~~N1~S f . However, I ha~-e changed my domicile to
(Street sod Number)
and am and have been a bona fide resident of the State of Florida since ~ day of
N U14Rx , 19 !13 y and 1 reside at E• 1-d61T~Q ~
(Street and Numbcr)
~aKf ~l FI~CE ~Sr- L uc i~~ S'(~. ~ UC I E County, Florida,
(cnr) ' -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnsert here aoy pertinent facts, such u sale of property or business, or relinquishment ot empioyment at totmer
domic~7e, removal of family to new domicJe. purchase ot home. etc.)
~~a~roncac~am~~
EstabZishing residency for college purposes
FitEO ayg ?~~~pDED
ST. «C;; ~OUh7Y fLA.
RO;: f ; ~,ITR4S j
CLEkK C~~~~~~ COURt ~ ~
RFC~~? Y%?ir;~D~~~~
~ Mar ?~I IO o8 AN '13
25S251
,
I
~ I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
~ comply with al! other requirements of a legal resident of this State.
I .
; I FURTHER CERTIFY ihat 1 have no intention to return to my former domicile, and I intend to remain in
ST- L UC i E S i• l.uC~1 E , County,
Florida, permanently. «''Y~
i n n, e' f ~ r„n
~~C~.~.d~at.~,(n, ~Xx.
_ ~o .
.J . (Name)
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,~~i.,i~ ~ : ~ (waa«u~
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~ S ~ ;~c}~t~nbcd bcfom mc this day of _
,
; r_ 'Y .
' ~ ~ ~ A. D. 19.~~
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i ROGER POITRAS, CIERK CIRCUIT OURT , 600K~~~ PACE155i
~ BY V1 D.C ~
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