HomeMy WebLinkAbout0071 Declaration of Domicite and Citizen~hip ~
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"1~0 THE STAT~ AND COUNTY TAX ASSl:SSOR,
ST. LUCIE ,_CpUNTY, FLORIUA: .
'ft~is is my dcciaration of Domicilc and Citixensl~ip in the Statc of Florida that 1 am filing this day in
;iccordancc, and~ in conformity with Scction 222.17, Florida Statutcs.
^ it f~ h~ A/ /t,~h; Y~~ ~C and 1
1 was formerly a lcgal resident of ~~~r~ ~st,~~~
t r/ S 1~ G C~ S f~°~~ ~ . However, I have ~ changed my o icile to
resided at / /
(Street and Number)
ay of
a~~d am and have bccn a bona fide resident of the State of Florida since
f ~t`' ~ , 19-~and I reside at ~ ~ ~ / F /Z/ v ~ /C _ ' y.
_ (Street and Number)
> ~ ~ ~ ~ 1 _ County, Florida,
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cn~y~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~ ~
(lescrt here any pertiaent facts, such u saie o( prapertr o~ business, ot relinquishment of employment at tormer .
domic~7e. ~emoral of family to new domicile, purchase of home, etc.) ~
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION:
~
If entering children in school,
please list their names: -
n 1~a .zl ` .
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f i.~i; E~qisDEO
• ~.Li7~i~ .;~J1iIY FLA. .
f.GGc ~ _ : RAS
• ~~~;'r ;UIT CO~~_
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
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,I4~UftTLjER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
" ' ' ' ~ ST . LUCIE
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~ ~ to and subscribed be~ore me this day of ~
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~ A.U. 19 74 _ 1 ng~ y ress
~ ROG~R POITRAS ~ CLERK CIRCUIT COURT ~f P r~'P ~ FlOrida f
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~ ~ e ut Clerk _
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(To be execuled in duplicate anJ original fded w•ith Clerk ('ircuit Courl, and Japticate w~lh Tax Assessor) ~
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