HomeMy WebLinkAbout0856 Dectaration at uomic~~e ana Vijizensn~p ,
'CO TIlE STATE ANU COUNTY TAX ASSI:SSUR, ~
ST. LUCIE _COUNTY, HLORIDA: 2~6`~O
Tliis is my dcclaration of Uomicilc and Citizenshi~ in the Statc of Florida that 1 am Cling this day in
accorda~ice, and in conformity with Section 222.17, Florida Statutes.
i was formerly a Irgal resident of 1~~ ~~C , and 1
(Cl'ty) (State)
resided at ~ ct ~~l " .]iowever, 1 have changed my domicile to
(Sireet and Numbar) '
and am and havc bcen a bona fide resident . of the State of Florida since ~3-~ day of
~-~-G` 19~~_., and 1 reside at ~ ~ , d a^^ ° .
' (Stceet and Numbet)
~ ' St . Lucie County, Florida,
.
(~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(lnsert here any pertinent fscls, such u sale of propertr or business, or relinqulsAment oi employment at totmet
domicHe. removal ot family to new domicile, purchue ot home. ctc.)
ENTERING CHILDREN IN SCHOOL: ' J~ HOMESTEAD EXEMPTION:
If entering children in school, L•---~~
please list their names:
• J
~ , -
- - ~ F~ifo ~k~ ~~~e>>~a
ST. LUC~~ LJLlITr fLA.
~tQG~ - ~ ~:TRAS (
ClrRr t.s ,cU1T COUAT
Ac.r,~R- .t=~~,EJ
M~ 1~ ~i i91N'T~I
~
! • ~'~'65p
~
~
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1 FURTHER CEKTIFY that I will register at my tocal address when the registration books reopen, and
comply with all other requirements of a legal resident of this State. _
I FURTHER CERT Y that I have no intention to return to my former domicile, and I intend to remain in
t L~ ~ ST. LUCIE County,
~ ,
~ Florida, permanently.
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~ . ~ _ - ; ~ " ' ~ S IGI~IATURE
• . ~ .
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~ ~~~~..,rn to~ac~~.sub cribed before me this ~ day of p
~ - 74 . /D ~ ~ :~r ~Lcu ~ --4~
~ - ~ ~ A.D. 19 ng r ss
~
ROGER POITRAS, CLERK C CUIT COURT f~~~ ~ , Florida
~ .
~ gy c~ eputy Clerk ' ~
(To be eaec ed in duplicale and original filed w'ith Clrrk Circuil Court, and duplMate w~th Tax Assessor)
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