HomeMy WebLinkAbout1063 Declaration of Domicile and Citizensn~p ,
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"I'O Ttil•: STATG ANU COUNTY 7'AX ASSI~SSUR, •
ST. LUCIE 2'75G31
COUNTY, f~ LORIUA:
Tl~is is tny drelaralion af Uonticilc and Citir~nship in thc Statc of Florida ihat 1 am filing this day in
accordancc, and in conformity with Sectian 222.17, Florida Statutcs. "
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1 was fornierly a hgal residcnt of~~ , and I
itr) (state)
resided at • . However, 1 have changed m~ d~cile to
(Sttcet and Numbet) ~
and am and l~ave bcen a bo~ia fide resid~nt of the State Florida since ~,~ay of ~
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, 19~~`--, and 1 residc a~
~ ` (Stteet and Number)
`u~ , G ~ County, Florida,
(c~~y> •
and this statement is to be taken as my declaration of citizenship, actual iegal residence and domicile in the State
of Florida.
(Inserl here any p~rtinent facis, such as sale ot prupetty or business, or relinquishment of employment at fotmer
domicile, temoval of family to new domicile, purchase of home, etc.)
ENTERI*:G CHILDREN IN SCHOOL: HOMESTEAD EX~MPTION:
If entering children in school,
please list their names: ~
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~
F;LEi • ~"3~E0 ~
ST. LU:.:L =.':JNT7 fLA. ~
F.~^ - I'P,:.S
C~tyr, , ;~;I COllRT ~
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' FEe 2l ~ i 5o AH'1~
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3 2'75631
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4 .I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
~ comply witli all other requirements of a legal resident of this State.
~
~
R I FURTHE~ E~'!FY that [ have no intention to return to my tormer domicile, and I intend to remain in
r LL~-~ ST. LUCIE , County,
~ Florida, permanently. ~ 5 ta nr w no d A- E vaNS,
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~Gibf~tFto ~nd sub~ed before me this ~ day of ,
- - .~.y : ~ : /77
•'Ls~~q~~i' , A.D. 19 74 - . ) 7
~r' . • . ~-~I
, Florida
ROGER ~P_ OITRAS~. CLERK~ R~IJIT~QIIRT-
e;, .
- By eputy Clerk
,y.
;
~k (To be exec ed in duplicale anJ uriginal fi1eJ with Clerk Circuit Courl, and duplicate rvith Tax Asseuor) ~
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t:r ~ 224 PAGE~.U62 _ ,
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