HomeMy WebLinkAbout0022 ~ laration of DomicilE and Citizen5hip ~
Dec ~
. ~
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1(~ 'fliG S'1'ATE ANU CUUNTY TAX ASSI:SSOR, 2'~(~V2
ST. LUCIE _ COUNTY, FLOIt~UA: ~ ~
Tl~is is my dcclaration of Uomicilc and Citircnship in thc Staic of Florida ihat l am Pili~ig this day in
acroraancc, and in conformity with Scction 222.17, Florida Statutcs.
~ T /1/ ~i . and I ~ •
1 was formcrty a Icgal resident of ~~~y~ ' cs~.~~) ~
I However, 1 have ~ changed my domicile to
rrsided at (Street and Number)
_.r ~day of
.u~d am and have becn a bona fide resident of the State of Florida since
~,t~ ~ ~
, 19-1-.1-~ and I reside at o(Strat and Numbet)
- - - y , , ~~/~LC County, Florida,
.
( -~r)
a:~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Insert here any pertinent facls, such u sa~e oi ptoperty or busincst, or telinquishment of employment at tormer •
domic~e. removal of family to new domicile, purchase of home. elc.) ~
HOMESTEAD EXEM~TION:
ENTERING=CHILhREdren in
OOhool, ~
If entering c
please list their~names:
~ ) _
• -
FlLEO AV^ REC~?RDEO
ST_ IUCI~ ~.JUlITY FIA. ~
RO::i ~ , ~,:?RAS
Ci:aK ~~:=~U.? COUNT
az~r•: - _
! - h~ io 09 a~
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S
THER CERTIFY that I will register at my local address when the registration books reopen, and
I FUR
comply with all other rec~uirements of a icgal resident of this State. o
1 URTHER CERTIFY t t 1 have no intention to return to my fornier domicile, and I intend to remain in
ST. LUCIE , County,
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Florida~ ,~e,rin
~ar~ ntl4~
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~ ` ' c'iied beforc me this ~L ~ day of ~
- S"qt,~rp'Yoand~s b~ R_
; 74
_ ' ` _ A.D. 19
l • 1 ing ress
~ - ~ , Florida
ROGER POITRAS, CLERK CI CUIT COURT
~ r
~f By eputy Clerk ~
(To be execuie n duplic~le and otiginal tiled ~+~ith Cletk Circuif C~url. and duplKatt with Tax Assessor) {
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~ 225 PA~ 22 - `
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