HomeMy WebLinkAbout1025 Deciara~~on of Domicile and Citizenship +
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TO Tt1L• STA1'l: ANU C'OUNTY TAX ASSE:SSOR, !i~~~~
__ST. LUCIE _ COUN1'Y, FLORIDA: .
Titiis is my deciaration of Domicilc and Citizcnsliip in the Statc of Florida that 1 am ~lin~ this day in
acconlancc, and in conformity with Section 222.17, Florida Statutes. ~
I was form~rly a l~gal nsident of • Miami ~ Florida and I ;
(Cier) (sa~e)
resided at 20425 Marl in Road . However, 1 have changed my domicile to ~
(Strert and Number) !
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and am and have bt.~cn a bona fide residcnt of tlie State of Florida since Thi rteenth (13)day of `
June ,~9 68 and 1 reside at ~3112 Okeechobee Road
. (Street ~nd Number)
Fort Pierce . ' St. Lucie County, Fiorida,
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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 here any pertinent tacts, such u sale of property or business, or relinquisAment of employment st tormer
domic~7e. removsl of family to new domicile, purchase ot home, etc.)
• ~ HOMESTEAD EXEMPTIO : ~
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• FiiEC tti~ '~~CJ~~EO
Gary Anderson Thomas ST-~u~'~ ~~v"~' F~~
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ci ~F~, c : :S , cou~t ~
Rol l en Travis Thomas ' ~{r';: = f~
Mu~ '[6 Z 4o PN'1~1
2'7'7'77~J
The purpose of my filing this domicile at this time is to
certify that my children, listed above, are residents of
i this County and State and do make their home with me at the
j above stated address, in order to qualify for the Sample ~
; scholarship. •
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I FURTHER CERTIFY that [ will register at my local address when the registration books reopen, and
comply with ali otlier requirements of a legal resident of this State. _ ~
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
Fort Pierce , ST. LUCIE , County,
Florida, permancntly.
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~ ~ ~ ~a 'f arol d I . Thomas
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~ . . ~ : a - S IGNATURE ~
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~ ~~oiro~ ~to ~rid '~bed before me this ~ day of
~ ~ j. 'a~v~ 74 -
~ ~ A.D. 19 .
~ ~ J i ing ress
ROGER POITRAS, CI.ERK CIRCUIT COURT ~ rlorida
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' gy Deputy Clerk • -
(To be eacc ed in Jupti;:.te anJ uriginrl filyd ~vilh Clcrk Circuit Cnurt, and ~c wilh Tax Asxssor)
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