HomeMy WebLinkAbout1000 i ~
.Declaration of Domicile and Gitiienship
}
'I'O THf~ STATE ANI) COUN1'Y TAX ASSl:SSOR,
~ 2'~5584 !
`ST. LUCIE COUNTY, FLORIDA:
Tliis is my d~cl.uation of Domicilc and Citi•r.~nship in the Statc of Florida that I am filin~ this day in
accordancc, and in conforniity with Scction 22?.17, Fiorida Statutes. '
1 was formerly a legal resident of , and 1
~c~~r) (s <<~
resided at ~ L%Z~~ . . Nowever, I have changed my domicile to
(Street and Number)
and am and have bcen a bana fide resident of the State of Florida since day of
. ~
~~-~~s.~~ 19~~, and I reside at l Z 3/ ~ ,
~ r ~ ~ ~ • (Stteet and Num r)
. County, Florida,
(C~rr) -
a~id this statement is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State
of Florida.
(lnseri here any pertinent facts, such u sale ot property or business, o~ relinquishment of employment at former
domicile. removal ot family to new Jomicile, purchase ot home, ete.)
ENTERING CHILDREN IN SCNOOL: HOMESTEAD EXEMPTION:
~ .
If entering children in school,
pl ase list heir es: ~
~ -
,
~
;
~ta Ec~ ,t~. ; r.,-::,~F,UfB
ST- ~~.1C~: .,v;;M'7•Y Fi,4,: L~
, FG~c 'RA$ ~G
CIE::!; C6bRT
,:Fr~_.n '
2~ ~ 2~ ' T~J =
;~'~5584
r.
~ ~
I FURTHER CERTIFY that I wili register at my local address when the registration books reopen, and
comply with all other requirements ~f a legal resident of this State.
I FURTHER CERTIFY that i have no intention to return to my former domicile, and 1 intend to remain in
~ ~ _ ~l~-T ~ $T . LUC IE County,
Florida, pcrmanently. «"Y~ ~ ' -
~ ~ ~ ,
:
- . \ D~NFI L ) ~
~
S
Sworn to and subscribed before me this day of ~ ` _
I Z-- 3 ~
~ • y A. D. 19_~~.
~
ROGER POITRAS, CLERK GIRCnIZ~~URT , F2orida
~ ~
BY ~ Deputy Clerk
(To be ex ted in duptipte anJ originr! filed with Clerk Ci~cuit Coutt, and duplicate with Tax Assessot)
~ ~ 224 PACf 9~9
-
_ _ ~
- ~
~
~ ~ _ . _ _ _ ~
~ ~