HomeMy WebLinkAbout2619 2663'78
Declaration of Domicile and Citiz~nship ~
TO Tlll: STATE AhU COUhTY TAX ASSl:SSOR,
St.Lucie ~
______--COUN7'Y, (~l.ORIllA:
Tltis is my drrlaratia~ 01' Domicilc and Citiz~nshi~~ in thc Statc af Florida that 1 am filing this day in
accordancc, and in confarmity with Scction ''?2.17, Florida Statutcs.
} 3 ~ ~ ~ ~ c ~ ' ~r? ~ and 1
1 was Cormerl ~ Irgal residrnt of - ?
~ itY) e)
resided at _~1 ~ t..r~~4~~ . However, I have changed my domicile to
' (Streel and Number)
and arn and have bren a bona tidc resider~t of the State of Florida since day of
~ now .
, 19 ^ ; , aud I /~csidc at Y-.~ C~ ~~.z~,.y,_,~. u~ ' ~ ~.~p-
? +
~ (Street and Tiumber)
~~t~CJt~ ~.rv,~z . ~ _ . St . Lucie County, Florida,
(c~~y)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. .
(tnseri here any pertinrnt facts, such ss salr of property or beuinrss, or relinquishment of employment at tormer
domicile. temoval of family to new domicile, purchase of Aome, ete.)
2663'78
.
• fILEO ANU RECORDED
ST. WWE COUMTY FU.
ItOGE~ FQ~TRAS
CIERI~ CinCl~t COUR?`~
R~COR~ vF~~F',0.~...~~..
Ocr ~8 i0 io AN'T3
I FURTHER CERTIFY that I wi11 rrgister at my local address when the regisiration books reopen, and
comply with all other reyuiremc?~ts of a lcga! resident of this State.
6
! 1 FURTHER CERTIF at ! have no intention to return to my former domicile, and I intend to remain in
' ~~G~~ St . Lucie
, County,
Florida, permanently. «''y? ~
/
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: ~ ~ $ _ (Name)
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, . ~.i:~~• ~ ~ CA~n ~~yo ~AJdress)
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~ Sworn to;~~rtd s~scb~l~c~~}.icforc mc this/.______. d~~y of
; ;o , .Y
: ,
` - , A.U. 19 - 73_.
. r : • r., y' ~ : . = `
ROG~~"~0~~'~~~CLERK CIRCUIT COURT
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: - -^ay
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' ' ~ C.~ iT - - - ~ .
, Dept~ty Clerk- .
(To bc eatcutcJ in Juplicalc rnJ ~~nk~~n.d fd~•J .~dh ~'Ir~{. t'ircuit ('~~uN. anJ Juphratr ~~iU T~
~oaK'~`~ P~~E2618
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