HomeMy WebLinkAbout0061 Declaration of Domicile and Citiz~nsh~p ~
7'O Tt1I: STATI: AND COUNTY TA~ ASSESSOR, ~ 264446
St.Lucie
_ COUNTY, FLORIUA: .
This is my dcclaration of Domicilc; and Citi•r.cnship in thc Statc of Florida that I am filing Ihis day in
accordance, and in conPonnity with Sectio ~ 222.17, Florida Statutcs.
_ I was formerly a Iegal resident of _ , and 1
(City) (State)
resided at 4~Dy . However, I have changed my domicile to
(Stteet and Number)
an am and have been a bona fide residcnt of tl~e State of Florida since day of
now 03
, , 19~ and 1/reside at ~ ~
~ , /n~~~ (Street and Number)
~
. St. Lucie County, Florida,
(c~cr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(lnsert here any {+ertinent facts, such u sale of property w business, or reliaquishment of employment at former
domicile. removal ot family to new domicile, purchase of home, etc.)
Entering children in school:
a
~ ~ f,
Si~i~ r cocyl~rr~ q~
~r EF ~,E ~ vOrTp,~S
4`~~R~ ~FF:'°:llT~p~~ `
F1f0
9os~!'13
; _
~ 2644,~6
~ r .
; .
~ ~ -
~
~
_
~ ~
~
~ -
~ I FURTHER CERTIFY that I will register at my local address when tiie registration books reopen, and
~ comply with all other requirements of a legal resident of tliis State. '
z
~ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~
~ ~~~i~
~~G~'~i S~ . Lucie , Count ,
~ Florida, permanently. «'`y~ . y
~
~ -
_ 1'. C~/~ ' ~ ( me)
_ J, : i . ;
~ . , ~ ~G~,'G~,~/
- ~r •1~!'~j,_f , G~ y dJreu)
:~a • - .3 : .
~ Sv~orfi°.tQ_•~1id subscu~d before me this ~ day of
~ . _ ~ ~ ~ 7 3 ~
n A.D. 19-- ~
_~z~...~~._ ` • _ ,
~ ROG~~"'~tOITRAS, CLERK CIRCUIT COURT ~
~ R 219
~ ~uoK PAGE :
Y,y _ _ . _ _
Y-- ~ ~
~ . _B beputy~Cle '
~ , ~
(Tu be exeeuteJ in duplicalr anJ ~~rig~n.il t~ .•d Nith l'1: ~f~ ('ircuil l'uurt.:mJ Juplic~tr w~th "!ax Assrcux) ~
~•i ~
r~ "
, , ji
~ - - _ _ _ _
. _ . _....a_ _ _ ~ . . . - . . . :
~