HomeMy WebLinkAbout1510 Decl~ration of Domicile and Citizenship
'TO THI: STATE ANU ('UUNTY TAX ASSI:SSOR, 265511
St.Lucie
COUiV7'Y, F~ LORII)A:
Tl~is is my dcclaratioi~ of Domicilc and Citizcnship in thc Statc of Florida that 1 am filing this day in
accorclancc, and in conformity with Section 2~2.17, Florida Statutcs.
I was formerly a Icgal resident of _.(~L~ ~ , ~ and I
, fcilr) (sute)
nsided at ~ ~-l ~ . However, I have changed my domicile to ~
(Street and Number) +
and am and have been a bona fide resident of the State of Florida since day of
now / ~J~ ~
, 19~~, and I/~eside at l~
j~ l~ ~
(Street and Number)
~,p . St . Luc ie County, Florida,
(citr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Flori~a. ~
(Inxri here sny prrtinent facts, sucA as sale of properly or business, or ~elinquishment ot employment at former
domicile~ removal ot family to new domicile, purchase of Aome, etc.)
Entering children in school: .
~ 1 ~
~ _ FILfO ~tNDw ~itECOROEa r ~
~ ~G ( ~ •,J~
ROC£R ~p?TRA$
~ tXERIt CIRGNT t011R~ `I
RECOitO YfR!F~EDr,~~,~~
' Oa 9 l2 06 P~!'73
;
~ - ~
~ 265511
~
~
~ ~ .
~
~ ~ - ~
~ I FURTHER CERTIFY that 1 will registcr at my local address when the registration books reopen, and
~ com~ly with all other requirements of a tegal resident of this State.
I FURTHER CERTIFY thlt I have no intention to return to my former domicile, and 1 intend t~remain in
~ .
~ ' St . Lucie , County,
~ Florida, permanently.
~ -
~ ~
- . .
`n ' (Name)
„ , . .
~ ~ t S ~l ~ ,~it.
~ ~f '~~'~G~ j (waa~~~.
~ . ~ r; ~G
~ ~ SWottf"taQ?i,d:sutiscYi~ed brforc mc this day of
. ~ : C ~ ~
fwi '.::~..~h_.~
~ ~
' " , ~.D. t9_73_.
§ . . ...a~,•=-F--:~!'~ -
~ ='~~~~ITRAS, CLERK CIRCUIT COURT .
n:a .~~~s
~
~ . - ; - - - --n~ - _ c ~c~ gooK ~19 PA~f 1509
eputy er
_ (To Frr circulcd in duplir.i~. ~nd uri~t~n.~l ~ruh t'Irrk C~rcuit Court. anJ duplicatr wilh Tax Assessur) .
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