HomeMy WebLinkAbout0599 I~e~la~•a~~~r~ af ~ar~~~^r~~ ~ ~~~i ~~~~~.~~;~~f ~:;a ~
f~) 'I'l l[: STATt: A\1) CUUI~'I Y'fAX ASSf~.SSOIt,
St . Lucie ,26'70~ Jr
C'C)UNTY, t~ LOlttl)A:
"fhis is my d~•cl:~ration of Domicilc :~nd Citizr~~shi~~ ii~ thc St.~l~ of rlori~la that 1 an~ filin~; this ~I~ty in ~
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.+~iorclat~c~•, ancl i~t confonnity with Scrtian 222.17, Flori~la Stat~itrs. ~
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]~vas farmrrly a Irgal residcrtt of ~ ~
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(c~ir) ! (s cc)
rr.idcd at . Howcvcr, I ha~~e changcd rny domicile to
(Stcett anJ Kumber)
a~~d am and have bcen a Uona fidc residcnt of thc State of Florida since ' ~ day of
now ~
- , 197~., and 1 /reside at _
(Street snd N m r)
- S t. Luc ie County, rlorida,
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:;n this statemcnt is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of I~lorida. •
(Instrt here any pertinrnt facts, such as s:ile of prope~ty o~ Dusiness, or relinquishment of emplo)~me~t al [ormer ~
domicile~ remo~•al af family to ne~v domicile, purthasr of home, rtc.) ~
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Entering children in school: -ji'!o'Zc.~ ;
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~ fILED Rhp F,E~ORDEO ~ '
_ ST, IUCtE ~OUNtY FLA. '
RGCE~, cptrRAS ~ ~
CIfF.K C,q~UiT ~OURT ~
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~ Oc~ ~b 113s PN'73 ~
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' I FURTHER CERTIFY that I will register at my local address when the registration bookc reopcn, and
; comply with all otl~er requirements of a legal resident of this State.
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~ I FUR ER CERTIFY t~at I have no intention to return to my former domicile, and I intend to remain in
i
; S* . Lucie , County,
` f~lorida, rmanently. (c'cr~ - <i
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: Sa-orn~t~ierid'stt~sEt~b~d beforc me tt~is day of !
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_ . , i ~ ~`t"~ ~ e t~,~ _ A.D. 19- 73 . i
2 ~,~;ROGER POI~'~; CLERK CIRCUIT COURT .
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(Tu bt execulrJ in Juplica~r anJ uri~tin:~l (i1rJ wilh ('Ir~k Circuil ('uurl. and Juph:atr Nith T-rt Asscuor) ~ • j
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