HomeMy WebLinkAbout0749 - - - . . . . . . . . _ . _ - -2 8
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E3eC~~ra~~an d~ ~aj~lCEt~ ar~~' E1ti~~nSi~~p . ;
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'PO TtiE STATE AND COUNTY TAX ASSGSSOR, ~ ~
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~~-~-W~COUNTY; rLOR1DA:
This is my dcclaration ai Domicile ar~d Citizcnship in thc State of Florida ihat I am filing this day in ~
acoordance, and i~ conformity witli Section 222.17, Florida Statutcs.
1 was formerly a legal resident of T~e-ri.,rz.1 • and I
tCttrl (Stat•) i
resided at y: 3`Gn - s I~ ~ R e.SA G-=. 'AL UG Fl~ . However, I have changed my domicile to
(St~eet and Numbcr) " -
and am and have been a bona fide resident of the State of Florida since 8'`f day of
, 19?.~.~ and I reside at y_Qt~~--~•Q•~- -
(saeee ana Numoer)
per,~ ~S7'. , ST County, Florida,
(~ir)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. _ ~ .
(Insert hae any pertinent iscts. such u sale ot p~operlr or business~ or relinquishment ot empioyment at forma
domic~. removal ot hmilr to aew domicile, purc6ase of home, etc.) ~
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Applying for homestead . . . _ . ~
~ Entering children in school : v • -
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L'V ''!.~-K-~
G,.~c.c,.G . - '
. . 1~ ~ 26p~?$~
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fIIED AAp RECOROE
. ' ST. IUCIE COUNTY p4~.
- Cl RK~C ~CU T C URT
. , RECORD VEqiF~~O
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~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
t comply with all other requirements of a legal resident of this State.
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E I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
t ,
PU.~ ,~S . ~.,..w~_~ , s I ~,~,u`s~ , CountY,
Flo
~et~tiy. (cjtr)
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~ ~ ;,~`4~' ~:~.s' A (Name)
i = ~r • -i ~Sf ~ Q ~ . ,
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~ ~ • ~ ~ ~ ~ ~ a 3 ~c 6L...,..~,~_~ ac~-~.. C~Q,z sr.
~ ~~~•ti - ~ • . ~ ~ ~ (Address) -
S • ~ O•~~a,',~~. ~ .
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n~~~=,~~b3cribed betore me this ~ day of
, .
A.D. 19~ '
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! ROGER POITRAS, CLERK CIRCUIT COURT ~
~ ~ 30PK 21~ r~~t ~
By . /`f ~..~C~.~ D . C .
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