HomeMy WebLinkAbout2751 Declar~a~ion of Damici~~ ~nd Ci~izenship
~rc~'1'llt: STATI: ANU C~un"fY TA:C ASSI~.SSOR, ' 264,2'~s
st.l.ucie _ _ _c.0uN7'Y, rl.URIUA:
Tl~is is niy d~rlaration of Dc~micilc and Citizcnship in thr Statc of l~lorida that 1 am filin~; this Qay in
;iccorclaiicr, anc! i~~ confonnity with Section 222.17, Florida Statutcs. '
_ _ _ _ _
_ : . -
1 was tonncrly a Icgal residcnt of _ _ , ~ _ - - ~ _ ! - -
lCilY). (State)
resided at ~ ~ ~ However, I have chan ~ d my domicilc to
' (Street and Number)
:,:~d am and have becn a bona fidc resident of thc State of Florida since day o1'
now ~ ¢ ~a~i.~c. ~,oaco~
_ , 19~~, and 1 /~eside at
~ ' (St~tet and Number)
~ St. Lucie County, Florida,
.
c~tr)
and tl~is statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of' Florida.
(Inseri here any pertinent facts, such u salr of prope~ty or business, or relinquishmenl of employment at former
domicile. removal of family to ~ew domicile, purchue ot home, ete.)
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Entering children in school:
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ST. tt~C+f Cpu11
ROG~F POI~~~S
CLER1( Ci~CWT CQp~t
RFCCRD '!i Ft: rtf 0
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1 FURTHER CERT[FY that I wili register at my local address when the registration books rcopen, ~nd
~ is t tc.
~
I FURTNER CERTIFY that I have no intention to return to my former domicile, and I intcnd to remain in ~
~ ~ St . Lucie Count ' ~
Florid~,:~l~nentiy. catr~ ' ( ~/,q,y,~l~~i• ) , Y~
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ts - ,~~'L YT ' ~ ~ ~ - (Namc)
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~ '~v(~q~ri,t~~~1~c~t38ed before me ihis day of
.s.,. . .
~ C~F R4~.:~,~~<< ~
~ S~r A.D. 19__73~
ROG~R POITRAS, CLERK CIRCUIT COURT
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~ - - - -
. ~ - ~Y-- De_ u~: . I e r -~1 ,
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(To bc eaeculcJ in Jupli.atr and urigin.d (ilri ~i1h ('trrk C'ircuil C'uurt. and Ju~li.~le ~+ilh 7ax ~~+SCSC~n)
~ d00K 218 PACE ~ /
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