HomeMy WebLinkAbout1300 ~leclaration c~f Domicile and Citizenship '
7'O 7~t1E STATl~ AND t'UUNTY 7'AX ASSESSOFt>
ST. LUCIE ~~5S~O
____4_. _ COUNTY, FLORIUA:
'Il~is is my d~claration of Domicilc and Citizcnship in th~ Statc of Florida that 1 am Fling Ihis day in
accordancc, and in conforn~ity with Scction 2?2.17, Florida Statutes. ~
I was forme~ly a legal resident of _ `1.S i~l~F and I
(c~~r) sisc~)
resided dt ~-1- 07 _4_ ~ ~ T~'r
~1- . However, I have changed my domicile to
(Stteet and Number)
and am and }~ave been a bona fidc resident of the Statc of Florida since day of
_~~ec S T 9 7~, and [ reside at ~d a ~6d ,r~ /P/ ~'f/ 5 T~Pe~erj'
(Strcet and Number)
~rE'T oSr u c/t , oS j' u~ i~~ County, Flarida,
(c~ty) •
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in tl~e State
of Florida.
(Insett here any pertinent facts, such as sale of property or business, ot relinquishment of employment at former
domicile, removal of tamily to ne~v domicile, purchase of home, etc.)
ENTERI:~G CHILDRE`~ IN SCNOOL: n HOMESTEAD EX~MPTION: ~
If entering children in school,
please list their names:
~
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~ FILEC Y.~~~~DEO
` S7.LU~l~ ::aUHTY flA.
E RUi;'t~ . .;iiRAS
I ~t:r.~_ _ . CCURT -
R~ n-r s: . " ..:1
I
` FE8 ZB 3 oz PH'~~I
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2'758~0
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with aU other requirements ef a legai resident of tliis State. -
i
I FURTHER CERTIFY that I havc no intention to retutn to my former domicile, and I intend to remain in
c ST. LUCIE County, :
~r. s ~ u ` ~ ~
, ,
Ftorida :permancnNy. ~c"y~ -
• ~ >y~ ~
r`C%.• ; t Ll~
•c;~ ` .i.
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' • ~ ~`t,•~ (/~/fl ~.i~ ~~/Q~ .
Swotn~Q_ arid.'~e~ctibed before me this day of _ ~
~ ~ C-CC~" '
~ , A.D. 19~_. ~
ROGER POITRA R~.I)ITS.OIIBT__ - ~~~GC.I.~-~ , Florida
S,- ~LE ~
By ~ F eputy Clerk
~ ~
(To bt executed irt duplicate aod otiginel Glyd vvith Clerk Citcuit Court, anJ duplicate with Tax Assessot)
~
c=~~~ 224 FAGE~.299
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