HomeMy WebLinkAbout0775 Decl~r~~ion of L~omicEte ar~d Cifiz~~~sh~p
269248
"f0 Tli[: S1'ATt: AI~'ll ('Ul1NTY TAX ASSI:SSOIZ, ~
St.Lucie
CUUNTY, l~LURlDA:
Tl~is is mv drelaration of Domirilc and Citixrnsl~ip in thc Statc of l~lorida that t am filing _this day in
accor~lancc, and in confonnity with Scction 222.17, Florida Statutrs.
. ' - ~
1~vas formrrly a Icgal residcnt af ~ , and 1 f
~'[/-~!%~'L~%~-~i (CitY) (State) ,
r~sidrd at _ . However, 1 liave changed my domicile to ;
(Street and Numbrr)
and am and hav~ bccn a bona tidc rc~idcnt ot ihe State of Florida -since ~ 4~ day of
~ now f'
- - , 19_ ~ 3 , and I /Fe~idc at ~ ~ ~ ~ -
, . (St~eet and Numberj
_-~.t_~ ~y6~~ St. Lucie
. County, Plorida,
(cit~ )
and this statement is to be- taken as my declaration of citizenship, actual Icgal residence ai~d domicile in the Staie
ot Florida.
(lnseri hcre any prrlinenl facts, such u sale of properly or business, or rrlinquishment of employment at fotmer
domicile~ remo~al of family tu new domicile, purchase of home, etc.)
Entering children in school:~ Homestead Exem tion: L_1
/..na, .J w.w p .
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~
~ 269~48
~~`~~~~R~
o~i~i~r
RECORO
y~~j
~~A COU1tt -
~
~v 11 E~ Y9 ~ ,?3 _
,
;
I FURTHER CERTIFY thai I wil! rcgistcr at my local address when the registration books rcopcn, and
comply with all other requiremcnts of .i le~al resident of this State.
I FURTHER CERTIFY th I have no intention to return to my former domicile, and I intend to remain in
G'z-~1- - ~ '
~.~r.~~..G St . Lucie County, ~
Florida, perniancntly. ~~'~Y~ ~ ~-fAu n/ ~
' ~-U
(Name)
~7~~ ~ ~
(Address)
- '
Sworn to and ~subscribcd bcforr me thi~~
7~' a~y or z
'1i'i ~1
- A.n. ~9_ 73 .
~~~~~~;~4'S~, CLERK GIRCUIT C~URT
_ : r, . o :
s~ _ 0 R ~j ~
~ ry `
~+~i`` `s~y -~eputy Cle • _ - - 60~lf~.iG~ PACE 7~ . ;
. ,
~~~'•.1 ;
t.(.7l~~Frt cticculcd in duplicalc anJ ~~tigin.d (il.d ~vilh l'Irr~. (tircuit C~•iut. and d~~pli:ale w~lh "(a~ Axscss~ir)
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