HomeMy WebLinkAbout1659 . . . ~ ~
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rc~ ~r~ ii: s~rn~r~: nn~u c'UUNTY TAX ,~ss~ ~ssoii, 26'7'7'78
St.Lucie
_ _ CUUNTY, I~ LOl:II)A:
"tl?is is my dcclar;ition of Domicilc and Citizrnsl?i~~ in thc St;it~ c~f rloricla that 1 am (ilinZ; Ihis ~iay in
a~~or~lancc, and in confarmity ~vith Section ~''2.17, 1=1ori~ia St~tutrs. ~
I wa~ formcrly a lrgai r~sidrnt of ~ e~-~ y~ v l~ ~~k~ „4~ 1V " aud I
(CitY) (State)
r~~.idrd at S?-Z- g g S~ . liowever, I have cliangcd my domicile to
_ (Stre~t and Number)
and am and have bcen a bona fiele residrnt of thc State of Florida since day o1'
~ now
G , 19~~ and 1 /~residc at ~ ? b ~ r"t ~ R . _ C .
~ (Sucot and Number)
~ ~ ~v~ e St. Lucie ~
~~~~Y~ . County, Florida, .
a»c[ this statemrnt is to be taken as my declaration of citizer~ship, actua! l:~ga! residence and domicile in thc State
ot' Florida. -
;
Insert here an ' •
( y pertinrnt fans, such as s~le uf propetly or hwincss, or telinquishment of tmploymrnt at tormet
domicite~ removal of (amily to new domicile, purchase of home, rtc.)
. !
Entering children in school:
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I FUR~'HER CERTIFY that I will register at my locat address when the registration books reopen, and
comply with att othcr requirements of a leaat resident of ihis Statc. ~
!
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in y
E- ~ - ~ ~c ~ r ~ ~ S'- . Luc ie '
, County, :
F'lorida, permanentl}~. ~p h ~ 2 e 5 ~ e~z o ~
,
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- i~ . ~~-t/ `~La.K . l
(Name)
a
" _ ~ 7 ~7 1 ci-,,,.. ~ C -t- •
(Address) ~
s
~ to and subscribed before me this day of ~
1~ ~r i
'7. A.D. 19 73 . i
, ROGCR POITRAS~, ~ CLERK CIRCUIT COURT . ~
_ ___-.,..~-,s:....~.- . fl ~ Y~~t~v`~" {
' _g ~~L~_ BOOx~~
. • • -
~ ~ - . .y beputy ~l.erk~
(To be executeJ in Jupl~.atr rnd or~~~~oal tdrJ Nith l'Ir~l. ('ircuit Courl. and Juphcatr ~~ith Ta~ Asu:sor) -
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