HomeMy WebLinkAbout0029 ~ Declaration of Domicil~ and Citiienship ~
"I'O THE STATE ANU COUNTY TAX ASS~SSUR, ~Q~9
ST. LUCIE _ COUNTY, FLORIDA:
'Il~is is my dcclaration of Domicilc and Citizenship in the Statc of ~lorida that 1 am Ciling this day in
accorcfancc, and in conformity with Section 222.17, Florida Statutcs. - .
~ - ^/l l ~ ~ and 1
1 was formerly a Icgal nsident of Q W d S~'~ ' ~sa«)
(c.tiir)
residcd at ~ -s~ ~~'w A~S - Howcvcr, I have changed my domicilc to
(Street and Number)
and am and have br.en a borta fide nsidcnt of the State of Florida since _ day of
, • , 19~ and 1 reside at ~ v ~ ~ ~
_ r,~ (Strcet and Number)
S' J, L G C 1~ ~ , l~~'~ County, Florida,
- (ci~r) ~
a»d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(Inse~t here anr ~tinent facts, such u sale of propcrty or Dusinas, or relinquishment ot emptoyment st former .
domic~e. ~emoval of familr to new domicile. purchase ot home, etc.) ~
ENTERING CHILDREN IN SCHOOL: ~f/~ HOMESTEAD EXEMPTION:
If entering ~hildren in school, ~•--i
please list their names:
i
~ - ~
~ ~
~ ~ .
~~t, c~-~~r u?-
i+W~~ ~~r• a~S
~;~~c[."-ytlti COU~T
• Rff'~u`, r;~'~
~ ~ ~8 IO 44 AH'7~ -
~
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_ '77Q f~9 .
f •
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s
.
I FURTHER CERTIFY that 1 will register at my locat address whcn the registration books reopen, and
comply with all other requirements of a legal resident of this State. -
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
r- ST. i.UCIE County,
~f6R1 S/. Lr~cir - _ ~ ~
Fiorida, permanently. tc~ir)
~
~
~-;.!";~u~;: . (Rob~NS~ n?
~ i' . , _
~ . •~~b ";;t-~ SIGNATURE
^~c:; - x
t~ '~c;ibed~~icfore me thi• ~ 4 day of ~ ~
~ ' .
, " 74
~ ~ ' • ~ ~ n. 19 • i ing re s s
• p~~ ~+.~n~~ ~ : CLERK CI ' I T COURT ~ , Florida
~
+ _ ~Yi -
i ~puty Clerk
By~ _ ~
rx uled i•• r1c and original fiicd wilh Clerk Circuil Court, and duplicale with 'faa Assessor)
c~ c~ ~
. Q:~ t ~+G~ PAGE ~r7
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