HomeMy WebLinkAbout0100 Decl~ratian ofi Domicif~ and Citiz~nship
1'O TIiE STAT~ ANl) ('OUN"TY ~'AX ASSI:SSOR, 2644'78
St.Lucie
COUNTY, FLORIDA:
;
Tl~is is my drelaration of Uomicilc and Citizcnsl~ip in the Statc of Florida ihat I am tiling this day in ;
i
accordancc, aiid in confonnity ~vith Sectiun 17, Florida Statutcs. ~
I was fonncrly a Icgai resident of ~ , and 1 '
(c~~r - ~ (saee)
resided at ~28~ ~E ` However, 1 have changed my domicile to
(Strcel and Num~er) ~ ;
and a and have bccn a bona fide resident of the State of Florida since day of ~
now 6. ; #
_ - , l9 ~3 and I /~csidc at G ~S S ~ ~-~~~~t~' , !
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(Stree! snd Number) ~
St . Luc ie
' , County, Florida, ;
(citr)
t
and this statement is to be taken as my declaration of citizenship, actual legal residence and~domicile in the State ~
of Florida. -
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(Insert here any pertinent facts, such u sale of property or business, or relinquishment of employment at former ~
domicile, removal ot family to new domicile, purchase of home, etc.) ;
Entering children in school:
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FILED AHO RECOROED
ST. RGCf R ~OITRAS L~ ~l
CIERK C:~~UIT COURT ~
RE~OR7 v~k~~~E~
S~P T6 II 12 AH'73
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` 264478
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~ I FURTHER CERTIFY that I K ill register at my local address when the registration books reopen, and
~ comply with all other requirements of a le~al resident of this State.
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~ I FURTHER CERTIFY that J have no intention to return to my former domicile, and i intend to remain in
~ • :
~ St . Lucie County,
~ Florida, p.er.qpanently. (c~~r) ' '
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~ ~.11 ~ CO i~~` / t _ ~ i
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' ~~•J~~j, . ~ i
:~a i .yJ'
' ~ ~ - (Name) i
- : • ` ~ r~ • ~ - ~~S oS ~ ~ 2~ .
;i ~~1\~.. t:~ ~ q ' ~Address) ` ~
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. ~ - _x~e~y'~. t~ : = ~ ~
~ Sw"o~ti;t~a~ic~~.t~?s~t`~licci brforc m~ this _ ~ day of
<; E - ~
~ :L,.<<~`'~ ~`-e % A.D. t 9~73
/ F:
P.OGER POITRAS, CLERK CIRCUIT COURT
F3 ' _
_ ~ . ~ l,~? ~ aooK 2~9 ~a~ ~.OU
~z . -BY-- - - ~
15eputy Cle ~
=;u (To be ezcculed in dupli:cNr ~nJ u~~~•~n.0 i•J ~~i1h ('I.rk ('ir.uil Court.:~nd Jupliralr ~r~ll~ Tax Assc~u~r)
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