HomeMy WebLinkAbout2156 I?ecl~r~atio~ of Domicile and Gitiz~rtsh~p
TU T}It: STATI: ANl) COUNTY 1~AX ASSI~SSOIt,
St . Luc ie ~.UUN"1~Y, f~ i.o,t~ ~~A: 26fi035
Tl~is is my ~Irclaration of Domicilc arnl Citiz~nship in thc Statc ol' I~lorida that I am filing this day in
accordancc, and in cunfarmity with S~ction 2~'~'.17, I~lorida Statut~s.
1 was fornirrly a Iceat rrsident of ~ L~A y , - and I
(citr) (state)
r~sided at ~/~e..~~-~ - . However, I have changed my domicile to
(Strret anJ Nun~be~)
and am and ha~•c bcen a bon~ fidr residcnt of the State of rlorida since _ ~ day of
now ~ ~ ~
J v L ~ , ~ 9~ d~,a ~ /r~s~dt .~t _ / ~ ~ ~ .~'~-9 Nc ~ s
(Street and Numbe~) .
~ ~,~<-,Z . St . Lucie County, Florida,
(c~~r)
and this statement is to be taken as my declaration of citizensliip, actual legal residence and domicile in the State
of Florida.
(Insert here any perlinrnt facis, such u sale u( ptoperty oc busi~ru, or ~elinquishment of emploYment at formet
domicile, temoral of family to ne~v domicile, purchau ut home, ~tc.)
Entering children in school: ~ /~P .
~ ~ c ~A s,~- o ~ ~
- fIlEO AND RECOROED ~
ST. LUCIE COUNTY FLA.
ROGER ~OITRAS G
CLERK C~RCUIT COURT , 3~ ~
RECORD VE~ir1E~
! Oc~ IS Z 13 PN'~3
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~ 2~035
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I FURTHER CERTIFY that I will rc~ister at my locai address when the registration books reopen, and
~ comply with all other requirements of a leral resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my forn~er domicile, and 1 intend to remain in
~
~ /~i ~ G C , S~ . Lucie , County,
~ Florida, permancntly. cc~~r)
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CD l /'.~t~-~ ~s.~~`"~'`~--
' 'V;•1.~~'••. G.4 (Name)
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~``r: " ~ : -"r' • ~ x ' Uddress)
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" ' • ' •V ~.,e~.• r--
°y ~r~ri'1~.{0 :il~'d;~~d~ bcfore mr thi; day of .
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: ~ ~ CS~!. b
~ e rL. A. D. 19__ ~
3_
~a:.~ ~ • - ,
~~f ROGER POITRAS, CLERK CIRCUIT COURT
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eputy C1~
3:-,y (Tu be execul.J in Ju~~fi..dr aerJ ~~r~~~in.J t~l~•J ~+u t'IrrA C'ircu~t ('uurl. anJ Ju~.licale with Ta~ Asxssur)
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