HomeMy WebLinkAbout0670 - Decl~~ation of Domiciie and Citiz~nst~ip
"I'O TtiE STATI: ANU COUnTl' 'I'AX ASSI:SSOR, '
s t . Luc ~e ~ZEi9~58
COUN"fY, FLOltll)A: ~
This is my dcclaration af Domicile and Gitizcn.hi~~ in thc Statc of Flonda ihat 1 am filing this day in ~
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accordancc, and in conformity with Section ~32.17, Florida Statutcs. . . ;
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I was formcrly a Ic~al resident of - and I
lCilY)/ , S1ate) /
residcd at _~d?'1~t However, I have changed my domicile to
(Street a~d Numbrr)
and am and havc becn a bona fidc resident of the State of Florida since ~ day of
now
, 19-_._, and I %reside at ~1' ~G? ~rJ~t~~ ~ ?d~~
, ~ . (Street a~d NumDet)
,~~~y~~ ~ . St. Lucie County, Florida, j
6 -
(City)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inxrt here any {+ertinent facls, such as sale of p~operty or business, or refinquishment of employment at former
domic~e. removal of family to new domicite, purchase of home, etc.)
Entering children in school:~ Homestead Exemption: ~ ;
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1 FURTIiER CERTIFY that I~vill register at my local address when the registration books reopen, and ~
comply with al~ other requiremcnts of a legal resident of this State. =
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I FURTHER CERTIFY that, I l~ave no intention to return to my fomier domicile, and I intend to remain in ~
~ ~L~ ~ St . Lucie , _ County, ~
~ ~ Florida, permanently. cc~~r~ ~ ~ ~ ~
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- - (Name)',
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l ' . ~ S ~~j ~V - ' _ ~ ~7ZG' V~' ~.Rl~!L _ d
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~ ~ Sw~r~ ~o:ard.si~~cribcd bcfor~ me this day ot ;
~ r ~ . t~ ~ ` ' 7 _
~ ~ ~ . ~ ~ ~ e P A. D. 19_ _ 3 . -
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~ :«R~Ar~ ~?~ITRAS, CLERK CIRCUIT COURT _
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~ (To be rxeculeJ in dupli.ate anJ uri~•i~~.d (drd a~ilh ~'Irrk Citcuit Cuurt. anJ Jupl~:ate aill~ 'i~x Asse:~or) ~
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