HomeMy WebLinkAbout1697 D~cla~~~tion of ~?os~ic~~~ a~d Citiz~nshi~
i u"t lll: S"~A7'1: AhU C'UUN'1'Y 'TAX ASSI.SSUIt,
ST . I.UC lE , ~s12~
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This is my dcclaratic?n uf' Uamicil; and ('itizc~~sliip in thr Statr of Florida ihat 1 am filing this day in
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.~;~c~r~lanc~, and in ~onforn~ity with Scctic~r~'_??.17, Florida Stati~trs.
1 was forn~crly a Icg~~! r. sidcnt ot~ -----~r.?;~,~-Z1~.~_~~_ and I z
(CitY) (Statej
, ~~~i~ir~l at uJ[~ _ Howe~~er, 1 have changed my domicilc to
- (Strret and Numbrr)
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.~n~i am and have Uccn a bona Gdc residcnt of thr Statc of Florida since day of
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G~-- - , 19~~, ;~tid 1 residc at -~~v~ r~. ' ?
(Street and Number) ~
!/C/c~-' , .5-~ • UCIF' County, Florida, ~ ~
(c~~y) ; ~
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::?~d this statement is to be taken as my declaration of citi~enship, actual legal residence and domicile in the State ~
i}1 f=lorida. ~ ;
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(Inxti here any {~rrtinrnt tacis, sucA ac sale of property o~ busineu, or relinquishmenl of employmrnt at former
domicile, remo~~al of family to aew Jc~micile, purchsse of home, ete.)
ErITERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: !
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If entering children in school,
please list their names: _
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1 FURTHER CERTIFY that 1 will rcgistcr at my local address when the registration books reopen, and
comply with all otlier requiremcnts ~f a Icgal rrsident of tliis State.
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I FU THER C~:RTIFY that 1 ha~•e no i~~tcntion to rct«rn to my forn~er domicile, and I intend to remain in
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G~ ~ S.~ . ~v~/~ ST. LUCIE
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I~loriJa, pcnnancntly. ~c~tr) . ~
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- : ~ , S IGIIATURE ~ ~
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Sq~orJt•I6~and~si sc ~zi Ucforc me tliis da~~ of - f.
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i ing ress
ROGCR ~'OITRAS, CLERK CI ~CLTIT COURT d~21 S'-~ ~v~a Florida
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(Tu bc rarru in dupl~r:~~c rn~l uri~in:d fdrd ~cilh l'trrk ('ircuit Cnurl.: nd dupli.atr ailh Tax Asseswr) .
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