HomeMy WebLinkAbout0754 Declaration of Domicile and Citizenship
TO THE S"I~ATL ANU CUUNTY 7'AX ASSI:SSOR, 2~`5~8
_ST. LUCIE _ COUNTY, FLORIDA:
,
Tl~is is my dcclaration of Domicilc and Citir.cnship in the Statc of Florida that 1 am filing ihis day in
f
acconlance, and in conforn~ity with Section 222.17, Florida Statutcs. ,
.
1 was formcrly a Icgal residcnt of -~-Q~~ - - and [
(City) (State)
nsided at ~~Q /1~ ~ y~ ~ vro . . However, I have changed my domicile to
(Street and Number) ~I/~/
and am and have M.'en a bona fide nsident of the State of Florida since day of
p,r~ ~ e iP , 19 and I residc at a~~~ N E - S aL ~l~f1 ~ iR e L~
~ , . (Street and Number)
~i R~ ~ST ~ N C I P~ , ~ St . Luc ie County, Florida,
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile~in the State
of Fiorida. . ~
(Inserl here any pertinent (scts, such u sale ot ptoperty or businas. or relinquishment ot employment at former
domic~7e, removal of family to new domicile. putchase of home, etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: _
If entering children in school, -
please list their names:
FILEll t?t:~ ~:EGJP.DED
ST. LUGi~ ~JUNTY FIA..
RUCFi? ?'!3+T~AS ~
ClE^K C~~..U~T COURT
pECfR; 'v~~!F1=0~
~ ~ M~w i5 I s5 P!!'~~I
~':i'~:8 ~
1 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.
I FURTHER CERTIFY that I have no intention to return ta my former domicile, and I intend to remain in
: ' ST. LUCIE Count
, , Y,
Florida,, aneittl}i.
' y ; ; • r''''•. : ~ _ ~ / ~
. _j; -`~!1,~~
~ ` . , ' '
.
. ' ~ ~
: r:s , - . • i .
: . . . . ~ ~
` ,}_Y:,' - : v•;
: . : ~t ~ S IGI~ATURE
SwD~tt
~t~a~d~~~~c}^~~ed before me this ~~day of
_ E G ~t.
•'n~ttt!!L~i~~ii~~- , A.D. 19 74 . -
i ing re s s
ROGER POITRAS, CLERK C RCUIT COURT Florida
~
ny DepuL-y Clerk •
(Tu be culed in duplirate and uri~inal fded ~cilh Clerk Circuit Cuutl, aod duplicale wilh Tax Aueswr)
t,
- . BL~~ 7~
_ _ _ _ - -
.~~,r _ ~
_ _ - -
a~ ~ ~ ~ -
` ~
°a ~ _
~ , . _ .