HomeMy WebLinkAbout1058 Declaration of Domicile and Citizenship
TU Tt1E STAT[; AND COUN7'Y TAX ASSI:SSOR, 2'~f,79~
ST. LUCIE CpUNTY, FLORIDA: `
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This is my dcclaration of Domicilc and C.itizcnsltip in thc State ot Florida that 1 am fling this day in
accardanc:c, and in conforn~ity with Section 222.17, Florida Statutcs. ~
1 was formerly a Icgal resident of A~
A~t2~1LA , ~~1 and 1
~ (CitY) (State)
resided at r~~ ~ T . Howevet, I have changed my domicile to
(Street and Number)
and am and have been a bona fide resident ot the State of Florida since Z 4~ - day of
/~A,C c/~ , 19,,2~., and I residc at ~ yU1 S~•~O D~ A v~ L°T .
. (Sttat aad Nombet)
~T ST `dG/ ~ ' St . Lucie 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 Florida. .
(Insert here any pertinent fatts, sucA u sale of propertr or business. or relinquisAment ot emplormmt at fom~a
domicile. removal of familr to new domicile, purchsse of home, etc.)
HOOL: ~ HOMESTEAD EXEMPTION: ~
ENTERING CHILDREN IN SC ~
If entering children in school, ~~r-~ `
please list their names:
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~ `o ~J ~`S
j Tf1G ~ Y l~.iA,G O.Ca ~
FltED ~ri ~~;,~~D~B
ST. ~i?L,t ~ Jir~tTr ftA_
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and ;
comply with ail other 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 ~
~T S r !/G / G ST . LUCIE County,
~ Florida, permanently. (c''''~ ' ~
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~ -`i SIGNATURE
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~ ~~'Sao~ to and su~i~ed before me this a~ day oC
: r; , . -`a'
~'~v A.D. 19 74~ " .~.~2,[.~a ~ ~d~0~~~lJ~C ~T
~ M3i ing ress
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~ R~'~,`;;~~~''~`RAS, CLER CIRCUIT COURT PJ.'ST. L~/[,iG , Florida
~
gy Deputy Cler~
(Tu lx executrd in duplicale anJ ori~inal filyd wilh Clrtk fitcuN Courl, anJ duplicale wilh T~ Assrssot) ~
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