HomeMy WebLinkAbout0791 Declaration of Domicite and Citizenship
TO TEi~ S'1'A1'~ ANU ('OUN7'Y TAX ASSI:SSOR, ~~59~
_ ST. LUCIE ___CUUNTY, FLORIDA:
This is my declaration of Uomicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in con[ormity with Section 222.17, Florida Statutes.
1 was formerly a legal residcnt of C~IeS~' eR~ i e/(c~ nc.t~•i S. C• _ and 1
(c~cr) T ' (suce)
residcd at ~ ~ Nt9.~f..~4V~-~-~-=-- • However, I have changed my domicile to
(St~t
et
and Number)
and am and have bc~en a bona fide resident of the State of Florida since l5~ ~ day of
, 19 70 ' and 1 reside at ~ ~D e- ~c~ x ~g~ ~ .
. (St t and Number)
~J ~ ~QC ~ , ' St . Lucie County, Flofida, ±
(c~~r) i
and this statement is to be taken as my declaration of citizenship, actual lesal residence and domicile in the State
of Florida. .
(Insert here any pertinent f~cts. such u sale of ptoperty or ~usioess, or relinquishment of employment st [ormer
domicJe. removal of family to oew domicile, purchase ot home, ete.)
ENTERING CHILbREN IN SCH~OL: HOMESTEAD EXEMPTION: _
If entering children in school,
please list their names: ~
• ' .
F~~EO a~._. -~:c~aoEn ~
- - SZ. LUCii .•JU~iTY FLA. ~
R~cE ~ i;~•'R~S ~
Clf~!( C."~Cut3 CO'JRT
oF.^,f~: . - . -
: M~rt 3 29 PM'~~I
~
~
~ . ,
~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
corr,ply with all other requirements of a legal resident of this State. _
I FURTHER CERTI~Y that I have no intention to return to my former domicile, and I intend to remain in
~ieRC~ ~ ST. LUCIE , County,
Florida, permanently. (c~~r) "
, ,
, ~3 • ~
.
_ _ ;
• . - = ~ _ - ( ~P~?~Cc l d ~ - ~ ~c71 ~
. ~ . . -
. . : = ~ S IGI~iATURE
, . j;_ „ = ~
- -
S~t+orn'tQ_an~ ~ub~cribed beforc me this ~ ~ day of ;
^!r~.«f'Q A.D.19 74 `
- ' i ing re s s a
ROGCR POITRAS, CLERK C RCUIT COURT , Florida ~
~
IIy r.~ Ui eputy Clerk • ~ z
~
(To be esecut in Juplicate and uriKinal (ilyd wilb Clrrk Circuil Court, and Juplhale with Tax Assrssur)
~ $a~ 225 7~9
~ . - , `3~-~
~ ~ ~ ;
+~'v~{'~ , ~S
~ f~'~~,~~
_ _ i`fiiss"' _
. a~ _ ~ _ ttv..~ _ _ . ifr zme~-~ _