HomeMy WebLinkAbout2996 Deciaration of Domicile and Citizenshi~
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TO TtIG STAT[: AND COUNTY TAX ASSI:SSOIt, 264396
St.Lucie
_COUNTY, FLORIUA: ~
Tl~is is my Jcciaration oC Domicilc and Citizenship in the Statc of Florida that ! am filing this day in
accordanrc, and in conformity witl~ Sectian 2?2.17, Florida Statutcs.
1 was formerly a iegal resident o[ ~re ensbe v' o , l~D~~~ ~~v ~i
ns and I
(City) (state)
resided at h~b 9~ h= ~~V e•_ . However, I have changed my domicile to
(Sutet snd Number) •
and am and have been a bona fide nsident of the State of Florida since ~day of
_ _ _ _ _ _.now_-------- ~ _ ~
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, 19~y and 1 ~eside at - • ~
~i~ / ~P?' csu«~.~a tv~~n«) .
c~ , St. Lucie w County, Florida,
(c~~r)
and this statement is to be taken as mx declaration of citiz~nship, actual legal residence and domicile in the State
of Florida. ~
(Insert here any pertinent facts, such u sale of property or business, or telinquithment of employment at focmer
domicHe. removai of family to new domicile, purcAase of home, ete.)
~
Entering children in ~chool: ~
~
_ •fILED Ay~ RECOg ~a -
; ~Sj7.~UC~E COUHTY~y,A.
' • ~ •ROCER POiiRAS '
CLERK CIaCU~T.COURT
RECnRa ~ER F~E~ '
~ ~ ~~5 sl~ :~.AH'.73 '
` ~ s~~° 1~ ~o•S-g A.m
~ _
~ - 264396 ~ ~
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~ r.
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I FURTHER CERTIFY that I wilt register at my local address when the 'registration books reopen, and ~
comply with all other requirements of a legal resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in
~ ~~P~t ~ - ~ S~. Lucie , County,
~ Florida, per~iar~enUy. cc~~r~ .~ydbie ff l(!2 /tESrS~
~ .....~~i.....,,~ " ; " " ? ~ i
, '
" ~ ~O'~ (Name)
yz; i ; e~J . ` ' ~ + . J
~~i} ~ : } ;'^i:, 'a ; ~ v ~l - Li~~ . .
~ .'~i~I~'~~' ~ ~
. ~ Q ~ ~ (Addreu)
t1~' • 'f~S' ~I - ~
~ ~ t~~~~~ f~ ~ -
~ 3yvo~ft~i~'~Sttb~cpbed before me this ~~-day of ;
~ 't,,~.(i~tE' ~E~ ~ 73 - -
~ ` , A. D. 19- y
~ .
~ ROGER POITRAS, CLERK CIRCUIT COURT-~
~ - ,
. _ • a" ' - - . ~y -
~ < fie~ut~~4 -
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(To be executeJ in duplicatr aoJ urigu f~lyd with ('Irrk Circui~ Cuurl, anJ Juplicate with Tas Assessor)
,
~ eoox 218 PACEz99z ~
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~x~~.~_ . .