HomeMy WebLinkAbout2975 Deciara~ion of Domicile and Citizenship '
'f0 THL• STATI: ANU COUNTY TAX ASSESSOR, 2'79Q93
ST. LUCIE COUNTY, ~LORIDA:
'il~is is my dcclarution of Domicilc and Citizcnship in thc Statc of Florida that I am filing Ihis ~day in ~
accordancc, and in conforniity with Section 222.17, Florida Statutcs.
1 was formcrly a Icgal resident of 1~rF~~~~~ ~F , U~ R C j~~ ~ and I -
(Cilr) (State)
residcd at B x.~~ /PT~ ~ . However, I have changed my domicile to
(Street and Number)
a~id am and have bcen a bona fide resident of the State of Florida since ~ J~ day of
Q~'C~ry! f3E?~ , 19 ~
9~ and 1 residc at ~ z F~ A'~ EM~Q i,vl9 Y S!'fl~1J~/ 1~l kE' S
(Stteet and Tiumber)
~j ~S % 1 !J~ !E ~ St . Lucie County, Florida,
.
(cti~r)
and this staten~ent is to be taken as my declaration of citizenship, actual legal residence and.domicile in the State
of Florida. . ,
(Insert here any perlineM facts, sueh as saie oi properly or business, w relinquis4ment ot emplorment at forma
domlcife, temoral ot familr to new domicile, purchase of home~ etc.)
. ~ HOMESTEAD EXEMPTION:
ENTERING,CHILDREN IN SCHOOL. ~
If entering children in school,
please list their tiames:
FIlEO ANO RECOIl~EO
tT. ~uQ~E cOUMTY U.
ROGER POITRAS ~
~ CLERK CI::CUIT COURT
aECOR4 vEa+~ tEo
a~ ~ fi~
~ . .
2'~?93 -
I FURTIiER CERTIFY that I will register at my local address when the registration boot:s reopen, and
comply with all other requirements of a legal resident of this State.
1 FURTHER CERT[FY that I have no intention to return to my fo~rmer domicile, and I intend to remain in
ST. LUCIE County,
P~''=~ L v~ i t _ ,
~ ermanac~tl~ cc~~r~ -
Floridaf ~ ' . ~
~ F ~ •~~'..~~1_~,f.`~ ; , ti
! . O,
; ' ~ yl- -
~ . ~~~`J • t~t~r~, _ ~
'r~ - ~~Lt~?i ~lif.x/ ~~1~~~
~ , . S IGNATURE
- ,
^y,, i
Swo .a~~l~yb~c~ibed Lefore me ~is day ot ~ F.[ A~l C.t~ r ~ w~ y- S?i~iViS~ ,LiSt~'k~ `
A.D. 19 PT• d i Lvc~E 33~fZ
~ i n g re s s
R R POITRAS, RK C RCUIT C~URT , Florida
B~_ eputy Clerlt
(To hc ezecu in dupli.ale anJ oriE:inal f~trd ~~~ilh Clcrk Circuit Cour:, rnd duplicale ~~ith Ta: Aursor)
• d at j~~ ~4~?.~~
~ ~
- ~~r,. ' ` - _ .,c~~
~ ~ i
` =R,
$
. - ~~J. ~u~ 7M^r ' - -a~. _ .