HomeMy WebLinkAbout0741 Deciaration of Domicile and Citizenship
'fO.Tlll: STATI: ANU COUNTY TAX ASSESSOR, iZ~S7U
_ST. LUCIE _ COUNTY, ~LORIDA:
~
Tliis is my dcclaration of Domicile and Citizcnship in thc Statc of Florida that 1 am filing this day in
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accorclance, and in conformity with Section 2?2.I7,~Fiorida Statutes.
. 1 was fonnerly a legal resident of • C-~t~ .and I
(cit~ (state) .
resided at ~~~1Qi j~«~" . However, I have changed my domicile to
r (Street snd Nuniber) •
and am and have been a bona fide resident of the State of Florida since ~ day of
c' , 19~ and I reside at , ~ ~
. - (Street and Number)
' St. Lucie County, Florida,
.
(city)
and this statement is to be taken as my declaration of citizensliip, actual legal residence and domicile in the State
of Florida. -
(Insert here any pertinent fxts, such u sale of prope~ty or busi~ess, or reli~quishment ot employment at former
domicJe. removal of family to new domicile, purchase of home. ete.)
SCHOOL: ' r HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN ~
If entering children in school,
please list their names:
/ ~ ~,0~1~
. f tLE t h`-.. ~'ti ~~RDED
st. WL._«.~eMaeS`~ L
RG COURT ~
Ct -
qsr,:.~~': ti= ; -
, ~ ~5 1 3o PM'~a
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E 2'7'75~~
I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with ali other requirements of a legal resident of this State. _
~I FURTHGR CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in
3 ~ - ~ C ~ ST. LUCIE , County, ;
Florida, permanently. cc~~r~ _ ~
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~ ' ~,~l,•. 3' . ~~CIC/~/f d
~~'h ` , ~ ~ ~
~ ' r _ ~ . S IGNATI)RE `
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~
~ : ~i ` ~=i : T~ ~
~ ~ day of
SvirQt~t. to and, su '~i~d before me this ;
, r~.;..,. . ' ; ~ A. D. 19 74 . " ~ ~ /~.5 l",~~ . ~
a ' i1~ng res _
~ ROG~F ~POITRAS CLERK C RCUIT COURT
, ~~.,,~~~~c~~ , Florida
~ .
gy ~,(~r n ~ ~ eputy Cler~:
(7u . led in Juplicale and e~riy.in~l fi1rJ with Clerk Circuit t'ourt, and JuplNate wilh Taa Asseswr)
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