HomeMy WebLinkAbout0867 ~ 265028 ~
Deciaration of Qomicile and ~itiz~nship
"I'U Tlil: STATI: AND COUNTI' TAX ASSL:SSOR,
SC.Lucie
-----CUUN"TY, FLORIUA:
Tl~is is my drelaration of Domiciic and Citircnship in thc Statc af Florida li~:~t 1 am filin~ this day in +
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accordancc, and in conformity with Scction 222.17, Florida Statutcs. F
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1 was formerly a Icgal residcnt of , ~ --~~-~~and I ;
(citr) (st.te)
resided at ~/S
~ Z~ . However, I have changed my domicile to
' (Street and Numbe~)
<~nd am and have been a bona fide residcnt of the State of Florida since day oi'
now ~ ~
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, 19~y and I /~reside at '
treet and Nu r) T ~ !
~o~o St. Lucie
_ ~ , County, Florida, ~
(citr) ~
and this statement is to be takrn as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~ ~
(Insert here anr perlinent facls, such u sale ot property or businrss, w relinquishment of employment at former
domicile. rrmoval of family to new domicile, purchase of home, ete.)
Entering children in school: ~ ~
- 265U28
~ fILEO AHD RECOROEO
ST. LUC1t COUNTr Fu.
~~1~~~~~ P,06,F F~~~?a4S
CL~=tti ti?Cuii COURT ••t\~
RE,".r,k 7E ~
~ Ocr 3 I os PM'73 z
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I FURTHER CERTIFY that I will register at my local address when the rcgistration books reopen, and
~ comply with all other requirements of a legal resident of this State. .
~ I FURTHER CERTIFY that I I~ave no intention to return to my former domicile, and 1 intend to remain in
~ . ~ ~
fr St Lucie '
~ ~ ~ _ a~ > / _y , County~, ~
~ Florida, permanently. ~
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~~~~~~~u~~~~~ ~ ~N01IlE~ _
r~ •~COUp~:~+, • G~ . ~
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J~?.Aa=_~~(j~ • ~ dress) ;
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= givbr~~dni~ ~su~is~nbcd bcforc mc ihis ~lay of
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- ' `'•4 ~ ~ A. D. 19__? 3_. ~
"__`~~~•-~~OITRAS, CLEFK CIRCUIT COURT ,
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(To bc caeculeJ in dupliratr .~nd uti~•in.d 1 J w~lh L'Ic~R l'ircoit C~~nrl. anJ Jiq~lir:~lr vv~lb la~ As.xsa~~) . ''s
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