HomeMy WebLinkAbout2855 . D~clar~t~or~ of Dornicile and C~tizen5hi~
I u 1 l ll: STA"l~t: ANU ('OUN'l Y 7~AX ASSI:SSOR,
ST. LUCIE 2'76949 ~
_ - - CY)UN7'1'. {~LORIDA: ~
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,
"fhis is n~y drelaratic~n c~f Uomicilr ana ('itif~nshi~~ in thc Statr of I~torida tlt:ii 1 am filing ihis day in #
~
.~<<uraan~~. and in confunnity with Srctio~i '??.1 Ftorida Statut~s. ~
R el,vo, ,_A_, P,w T2/tJ'~x--and 1 ~
i was farnicrly a Ir~;al residr~lt ot~ --_-~.A~-,a.---- .
(c~~y) (s~~?e~ ;
?~~.i~icd :~i C e~~- p _ . Howcvcr, 1 havc change~l my domicilc to ~
(Street aod ~mbe~) -
.?~i~i am and havr txen a bona rde resident of the State of ~lorida since day of
F i~
, 1973 and 1 residc at .~~1 G 3 .S .~N p IA N j~ 1 v l ~Z ~
(Streel and Number)
~ ~ C~ .N ~ V G ~ V
__L___ _ , County, Florida, . ~
(CSU 1 i ,
and this statement is to be tahen as my declaration of citizenship, actual legal residence and domicile in the State
~f Florida. _
~
(lnsert hete any prtlinrnt facls, such as sale of pruperty ar business, or telinquishment of tmploymrnt at former ~
domicile, temo~~al of family to new dumicile, purchasr of home, ete.) ~
.
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION:
If entering children in school,
please list their names:
1
~'i
• a~
fILE~ `:~~U~OED ~
St.l'.?Lii : :'JNTY Fl.~
R - , TAaS ~Q~
CiE' " " ~OL~RT ti1
o:~-: • rn U
KAl~ f~ 23 AN'~~ ~
f
s
2'76349 ;
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; 1 FURTHER CERTII=Y that 1 will rc~istcr at my local acldress when the registration bool:s reopen, and ~
~ comply with all othrr requirements of a le~*al residrnt of this State. ~
~
3
~ I FURTHER CF:RTIF~' that I have no intention to return to my tormer domicile, and 1 intend to remain in t
ST. LUCIE ~
~ ~ ~ 1Z G , County, `
~ y:
I~ iorida, pennahc.ntl (~~`r) ' ~
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~ - ~°-::.3 ~ . . _ . _ ~`o h,~ _w_ ~a. N d
~ • _ - S IGIJATUIt~ ~
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a~, ~ri~ect~i~cforc rTic this da~~ of
S~ti~orn'i~i" d;su ~ -
t . , ~ - 74 ~ 0 ~3 S. ''~w~+ $~~~t , .
A.D. 19______. 1 ing l~d ress
= ROGER POITRAS, CI.~RK CT _CUIT COURT !L~ ~ I'lorzda
; P,u-rc.t ,
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Ry ~ cputy Cl_Prl;
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