HomeMy WebLinkAbout1519 Decl~ration af Qomicile and Citiz~nsf~~p ~
ru 7~i~t: S"1'A71: AhU COUNTY ~rnx nss~:ss~ii, ~ ~'~5982
ST._ LUCIE LUUN'1'Y, ~LOltll)A:
Tl~is is my dcclaraticin of Damicilc ai~d Citizcnship in thc Stalc of Florida ihat 1 am Clin~ this day in
arrc~raancc, and i~i conformity with Scction ~22.17, Florida Statutcs. .
! was forn~rrly a lrgal resident of ~c.~(c~`y~.Q~~ , ~=S~C~ and I ~
nsided at /y,~- N~'P>n~~ 13~v~ . However, 1 have changed my domicile to
(Street and Number) S ~ ;
a,id am and havc becn a bona Cde nsident of the State of ~lorida~ since ~ day of
~`'~'4 , 192~, and 1 residc at ~ ~ ~°'P ' G'9 S q v ~ :
(Sueet and Number) i
t= ? ~ c R C' ~ . S;' ~G, c_ County, Florida, ;
(c~~r)
::~~d this statement is to be taken as my declaraiion of citizenship, actual legal residence and domicile in the State
af Florida. _
(lnsert hete any pertineot facts, such as sale of property ot business, ot relinquiuhment of emptoyment at formet
domicile, remorat uf family to new domicile, purchase of home, etcJ
ErJTERING CNILDREN IN SCHOOL: . HOMESTEAD EXEMPTION: ~
If entering children in school, ~
please list their names: !
_ .>c o 1~ A ~o S .
f<'~vT D N /A -
~
C'c /y kf~ R~~ s . F~LEO aK~ ~{c~a~o
FLL
s~ ~u~~: ~usrr
Pc `~'c~ FO:.c~. ~ :.-gAS ~
Clr: r -
`'r~C`%~: ~•~F;-`'~; CBUAT
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~:sss~ :
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1 FURTHER CERTIFY that 1 wilt register at my local address wl~en the registration books reopen, and
romply with all other requiremcnts of a Icgal msidcnt of this State.
~
~
~ 1 FURTHER CERTIrY that ! have no intcntion to rcturn to m~~ fornier domicile, and 1 intend to remain in ~
~ ~
~ c ~ ST. LUCIE Count ~
Flopda;,pern
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. ~ . . ;•4~'~ SIGI~iATURE ~
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S~voririq;aird i~bs'rribed bcforc n~c this day of -
, ~S
- A. D. 19 74 /G/8 ~ ~E'r~. ~ y s ~?v~
-
z ing ress
' ROGF:R PUITKAS, CLTRK C RCUTT CUURT ~ ~
, ~;'~,~c~ , Florida ~
gS? eput}? Clerk
(To tn exec IrJ in du~rlicate and uriFin:d tilyd ~+ith ('I.rk Circuit Coutl, anJ duplieale t~~iU~ Tax Asseuor)
~ ~ s 2~4 PAGE • ~
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