HomeMy WebLinkAbout1000 .
~~clar~~ion of Domicile and Citizenship
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~~~u ~~~fi~: s~rn•ri: nn'i) COUN7~Y 7'AX ASSI:SSOR, ' 2'~154'7 ~
S C : Luc i.e ~
- - COUN1'Y, f~ LORIllA: . ~
"fl~it iti my dcclaration c~f
Damicil~ and Citit~nship in the Statc of Florida that ! am filing ihis day in !
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accordancc, and in confonnity with Scction ?22.17, Florida Statutcs. _ , ;
1 was fonncrly a Icgal residcnt of ~~~/1'l7D/-~i'~ , /9 and I
~c~~r) ts~ e~
residcd at~~ ~~~._G~f . However, I havc changed my domicile to
(Strcnt and Numbcr) ~
and am ai~d have been a bona fide resident of ti~e State of Florida since day of
now
_ ~~L'~ , 19_~~, and 1/reside at e ~~.Y Z7~~-:~ ~iP-33g .~p
/__,C , ~ ~~c~_ ~~~K/O~ (Stteet and Number)
~ c;% ~ St. Lucie County, Florida,
tcti~r)
ancl this statenicnt is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State
of C'lorida.
(lnseri t~ere any pertine~t facis, such u sale ot property or business, ot relinquisAment ot empioyment at former
domicile~ remora! of (amily to oew domicile, purchase of home, etc.)
~~r/~~ 1~ ~~~'~=,f?~Z,S D •
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Entering children in school; Homestead Exemption: v ~
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n ca~ ~u y a ~
Ros~= ~a.T~s ~
C~ERit Ct;C1i~i COtJRT ~
ItF+;t,SA YE?it%;EQ
0~ ~1 10 S~ I~
~ 2'7154'7 `
I FUR'I'HER CERTIFY that I will register at my local address when the registration books reopen, and
con~ply with all other requirements of a lenal resident of this State.
I FURTNER CLRTIFY that [ liave no intention to return to my former domicile, and I intend to remain in
~/~oj~/'G ~ St . Lucie , Connty,
Florida, permanently. ~ ~
- • C` . ~~~r~'~ `~'~Y ~ / ` ~ ~ ~
~ i a 1~~ `%~r/' Y
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~ c,~ .:~.a_ (Name)
. _ : ~ ~Q~ ~~,D S^
- , ~ c-~ ~ (Address) •
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~ Sv~~o~'n~to~'~nd ytt~.~i.'ribed beforr me this day of
,
-'---=-'•-:~-G~-,'=~-~~ A.D. 19.._73_..
~ ROGEP. YOITRAS, CLERK CIRCUIT COURT
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. 0 R ~1~ pAGE~~ '
~ 8001( :
~ _Dy _ ~ Y~ ~`~1_~ GtCf,c ~ - `
I?ep;ity Clerk ~
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(la bc c~ecutrd in dui,hcatr ,~ud ~~ri~;~n.il fd.•c ul~ /7rt~. Circuit ('uutt, and dup6.•rtr aith T~c Asscsso~) 4
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