HomeMy WebLinkAbout2742 Decl~ratic~n of Dor~nicile and Ci~i~enship
2`76849
rc~ )11: S7'A"I~I: ANI) ('UUNTY TAX ASSI~.SSOIt,
ST. LUCTE^ ^ ~ COUN1'Y, f~LOttIUA:
Tl~is is my dcclar.Uion of 1)amicilr .~~~a c~~~~~~,si~;r in the Statc af Hlorida that 1 am filing this day in
.ic~or~lar.cc, atid in confor~iiity with Scction 2~?.17, Florida Statutrs. -
1 was farmcrly a lcgal residcnt of - and I ;
(Cit~ (State) ~
resiiled at ~~_a However, I liave changed my domicile to
~~i (Strent and Number) ' ~
.?nd am and have been a bona fide resident of the State of rlorida since ~3 day of '
19 , and 1 reside at ~ y~~ 7r ~ S`~.~c~' 1;
~ (StreN and Number) j
_.~.~~G~2-2~ ~ , County, Florida,
(City)
i
:+nd tl~is statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State j~
uf Florida.
(Inurt here any pertinent facts, such as salc of property or business, or relinquishment of employment at tormer
domicile, removal uf family t~ neK• domicile~ purchase ot home, etc.) ,
Er1TERING CHILDREN iN SCHOOL: HOMESTEAD EXEMPTiON:
If entering children in school, ~ :
please list their names: ~
2"~68~9 '
~
~
Ftt~U av•. ~E~~ROEO ~ ~
ST.I~l~.• „GI;NTY FIA. ~
oF^ C RG:~' Ot;RT
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~ i144 PN ~r~ ~ ~
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i 1 FURTHER CERTIFY that 1 will re~;ister at my local address whrn the registration books reopen, and -
; comply with all other requirements of a Icgal resident of this Siate. :
~
; I FURTHER CERTIFY that 1 ha~•e no intention to return ta my forn~er domicile, and 1 intend to remain ire t~
~ ~~~~,G~ ST. LUCIE , Co~u~ty, :i
~ (c~iy~ ~
rlorida, permanrntly. ~
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~
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; ~ " O~l-i i ~
; : ' ' - S YGNti7'LIRE
js
Swo~ri t. and sub~cribcd bcfor~ mc this _l~ da~~ of -
` ~~1=.e-'~~~.~- 74 -
- . A.D. 19----•
f ~ ~ - i ing ress _
q ROCER POI'CRAS, CLERK CIRCUIT COURT , Florida
~ fi
I3y lor~~~ De~uty Clerk _
3
(To bc rxrcutcJ in dupli: atc anJ uriE in.d 1~I~•d oilh ('Icrk ('ircuil ('uurl, anJ dupliratc M~iIA Taa Assessor)
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