HomeMy WebLinkAbout0846 Declaration of Domici~e and Citizen~hip F
~~o Tri~ s'fATE ANl) COUNTY TAX ASSGSSOR, z,~s~~ ,
ST. LUCIE -
GOUNTY, i~ LORIDA:
'I7iis is my declaration of Domicilc and Citizcnship in tlic Statc of Florida that 1 am Gling this day in
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accordance, and in conformity with Section 222.17, Florida Statutes. ~
1 was formerly a legal resident of ~ , ~ and I ~
~ ~~y (st,te) -
resided at ~ ~ . However, 1 have changed my domicile to ;
eet and Number) 3
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and am and havc becn a bona Gde resident of thc State of florida ince ~R~., y ol '
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19~, and 1 residc at _ :
_~~~~~Z . (Street and Number) ~
,R Q~ , St . Lucie County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. • -
• (Insert Aere sny {xrlinent tacts, such u sale of properly or business, or relinquishment oi employment at fotmer -
domic~le. remoral ot tamily to new domieile, pu~chase of home, cle.) ~
• ~ HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN SCHOOL. ~
If entering children in school,
please list their names: ~
~
F~~=_o A,- -~;L~~FOfO
S?.ltiL~~ _°.=iwTY fU.
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f.lE-tf. ~ ~ '^.i1RT ~
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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.
I F RTHCR ERTIFY tt~at I have no intention to return to my former domici}e, and I intend to remain in ;
. ;
ST. LUCIE ~ Coimty, ;
(c'~cr) ~
Florida, permancntly. i
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~ . SIGNATURE
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.~8~y,ac;r~zb ap~fl-SUbscribed i~eCore me this ~ day of
~ . ~ ` yt, ~ • ~ y 74
~ ~Q'~, cJ~ - A.D. 19_ ' 1 : /S F+ Q/1 ~
~ , . ~ ~ - ; . ~ : -a : ~ `ti~~'~3
i~.ng re s
~ ~tD~ER 0~~RAS, CLERK CIRCUIT COUR'~ ~ r ;
. - ~ o,,,c~ , Florida ;
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~ j' 4-~_ . ~ C' - . '
~B~r:' Deputy Clerk {
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(To be r culed in duplicale and urieinr) tiled with CIrrL Circuii C~wl, and Juplicale with Ta~ Assessur) ~
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