HomeMy WebLinkAbout2190 i~dtiV~4 ,I„j
Decl~ratior~ ofi Qomicile and Citiz~nship
TU THI: S"~ATt: ANU COUN1'Y TAX ASSI:SSOIt,
y St . Lucie ~UUN7'Y, t~ LURI[)A:
71~is is my dcclaration of Domicil~ and C'itircnshi~~ i~~ the State of ~torida ihat : am filing this day in
accardanec, and in conforn~ity with Srction ?2~.17, Florida Statutrs.
.
I was formerly a Icgal residrnt of , ~~~14~>>~-ct~='t , ~~f~ ~ ~ and I
,i , (citr) (state. .
rrsided at ~..0~~~1~ h- ~ _ . However, I have changed my domicile to
(Street and Numberj
and am and have been a bona fide residcnt of the State of Florida since - day of
now
, 19~~_, and I /~csidc at -
~ i „ _ ~ (Street and Number)
~ ~ St. Lucie
7~"t~ ~~L- County, Florida,
(cnr) ~
and this statement is to be taken as my declaration of citizensli,'~~i, actual legal residence and damicile in the State
of Florida. -
(Inserl here any prrtinent facts, such as cale of property or business, or ~elioquishment of employment at formet
domicife, removal ot family to nrw domicile, purchase of h~me, etc.)
Entering children in school:
zssos~
. ~ ~ ~
/l/~Gtv ~ g F~0 AND s~E~WttlE1
~ ft.LtiCiE CaI~NTY ftA.
~ KOGf.eZ ?OITitAS
i:(~f~t~ G~C4~~ N - CIERK C~RCtf1T COURT
L7~(/'CQi ` " RE~ORa V~R3FIEU
Oci 15 3 si PM'73
~
~ I FURTHER CERTIFY that (~vitl re~ist~r at my tocal address when the registration books reopen, and ;
comply with afl other requirements of a Iegal resident of this State. {
;
f I FURTHER CERTIFY thai I have no inicntion to return to my forn~er domicile, and I intend to remain in i
` ' 7,~~~;~ S t. Luc ie -
' , County,
s Florida, permanently. (c~lr)
~
€ ~t1_.~ ~C~ ~/~t~lrt.~r~
(Name)
~ . ..L't~- _ _ -
~ (AJdreu)
' Sworn to a~~ub~cribed betore me this ~lay of r
; ~ ~ ~
~
t • "
- , n.Ii. t~ __73_.
~~P r~:.CLERK CIRCUIT COURT
- ' =S' ~.y~~i>~~ -
-.t~. ' . ~ • : ~ I v' ~ ///'%C . i
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Y- - - -
5~;:~... Deputy C) e
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C't~Gt .
'r~~fHlr•l•t•••;`~u bc executcJ in dupli.atc rud ~~ri~•~n.~l I~irJ ~vU~ l'IrrF, l'itcuit Cuuri, and Jupli~.~lr ~a~lh "fa~ Asx~tut)
Bo~K219 ,A~~2~.89
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