HomeMy WebLinkAbout1651 Q~ct~r~~~on of ~:om~c~t~ a~~ ~~~~zensn~p
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~fU "fill: S~'ATI: ANU CUU1~'7'Y '!'AX ASSI:SSOIt,
_ST. _Lt1CIE _ ~,pUN~'Y, t~ I.OKIDA:
Tl~is is my dcclaration of Uomicilc .ind Citizcnship in the St.?tc of ~lurida that 1 am filing this day in
accor~lancr, and in coiiformity ~vith Scrtic~n 2~2.17. Florida Statutcs.
~~nt of En~ n,-~c~? ~ c~'C ~ S 1-~ ~~v tON and I -
1 was fornicrly a Icgul res~d~ ~s~.«
~c~ir)
- y~S QL M iR S~'• . However, i have changed m~~domicile to
residcd at
(Street a d Number)
~nd am and have txen a bona fide re~ident of ihe State of Florida since "Z ~ day ot
pt Q Lh f~ 19___~__, and 1 residc at S.U ~~S . D~• S• &A~ C I US Co %o n+}I
- - ~ (Street and Number)
5 e,~ ~q c.~~L St . Lucie County, Florida,
,
~ (ctiir)
and this statemeni is to be taken as my declaration of citir.enship, actuai legal residence and domicile in thr State
of Florida. . .
(Inse~t here any prrtincne tacts, such u sale uf ptoperty or business, or rrlinquishment of empluyment al fotmer
domicile, temoval uf frmily 1o nrw domicile, purct~~k ot hume, etc.)
.T . HOMESTEAD EXEMPTION:
ENTERING, CHILDRE?. IN SCHOOL.
If entering children in school,
please list their names:
~ ~R~N M • M E5~ kE
~-~-e P~?~,~ R~ M~s ~ kE 2~~?
~'~5
f1LEQ ~hC t~c
ST. L~CtE r_~ C~~QEO
ROC^;,. r,~~R~S U.
RFrr~CRk~ ~ ~~IT
C~URt
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A~R I t13z PH'l
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1 FURTHER CERTIFY that l wiil register at my local address wlien the rcgistration books reopcn, and
comply with all other requiremcnts of a legal residcnt of this State.
I FURTHER CERTIFY that 1 have no intention to rcturn to my fornier domicile, and I intend to remain in
R~ ST. LUCIE County,
J~szN , ~
Florida,•perma~:ntly. cc~~r)
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~ . - , . ~ ~ : _ . . ~ - S IGI~ATURE
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~ .•Sworn to anct s4~hscribcd bcfore mc this _f day of ;
,
~ . . _ t',~ ~ ~,c~ A.D. 19--74-• _
- • ~ ~T,c1 Z lli~ 1 E'_ S S
ROCC.°. POITRAS, CLEItK CTP.CL~IT C~~l?T - , Flc ~ da
;~v ~~c.-!'i ~t.Z-~ Del;:~~y Cl eT-1:
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(iu br r~e~ulrJ i:~ Ju~~lirelr . nJ ~~ii~i~~ ~1 f~!~ d v:ith ('Irrk ('irruit ('~wrt.:~nJ dupli::~tc ~+•ili?'fa~ Asccssi.t)
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