HomeMy WebLinkAbout1221 C~:y~~~~` ~~on Qf Domicite ~nd Citizenship z~9~s
7'O TI11: S'l~A~'l: A~U COUNTY "1'AX ASSI=.SSOIt,
ST. 1.UCI1: _ CUUN'1'Y, I~LOItIUA:
Tliis is my clrclaration of Domicile and Citir.entihip in thr Statc of Florida tliat 1 am fiting tliis day in
accordan~c, .?nd in conlonnity with Scction 2~2.17, Florida Statutcs.
I~v~~s fc~mmrly a Ic~::il residciit of , s s. and I ~
(citr) (state)
resided at ~i-t.~~- ~ H . Nowever, 1 have changed my domicile to
r (Street and Num~rr)
and an~ and h:~vr br,cn a bon;~ fide residcnt of the State of Florida since 1 S' * day ot
_~~~~L---- , 19_23-, and 1 rc~ide at -
(Street and Numbet)
. St . Lucie County, Florida,
(c:~~r)
and this statcmrnt is to be takcn as my declaration of citi7enship, ac:tual legal residence and domicile in the State
of Florida. ,
(lnscri hrre any pertinrnt t~cts, such as sale of pruperty or busincss. or rrlinquishment ot employment at fotmer
domicile, remo~'al o( (amily tu nc~v domicile, purchue of home,. tc.)
, . HOMEST'EAD EXEMPTION:
ENTCRI~:G CEiILDR~~~ IN SCHOOL. ~
If entering chi_ldren in school,
piease list their names: 2'~~'~s
f lE0 AN^ RECOROE~
s~• IUCIE GOUNTY Fl .
ROGEF POITRAS ~
CLERK C~:•CUIT COURt
RFCOR~ VEp+=~EO.~.~.~..~ 6y
~ Aett I~ 10 ~3 ~M'T~I
~
,
i .
~.~~a_.-+L.-~c.t- !t- c
/
~ ~ _
I FURTHLR CEhTt~Y th~:t I~vill rc~ister at my local address when the registration books reopen, and
comply witli all otl~cr rcquirements of a legal rrsident of this State.
I rURTH~R CERTIFY that 1 have no inte~~tion to return to my formerdomicile, and I intend to remain in
, ST. LUCIE County,
---L o r't ~.r c~ - ~ '
Fiorida, r~r~»~t~~~,ciy_ ~c~~,~>
s. ~ ~ _
_ _
,
h~
- ` / --~~~--~5 IG A RE
Sworn to an~l «~l?s::rihrd hcforc mr ihis ~ay of
~ t.~-L- A.I). 19 --74. /~4 _
- - i~ • ~ i ing i e s s
R0.^,L:: PUIT:Zt.S, C11EitK CI1;CUjT C~`U~tT n Florida
~'"r t r cp ,_,,,f `
T5y_` ~-c,+~l~ ~C'z`'f~-~~vt'I~ll[_~` CIE:'1C .
( iu b,• rae. utrd i•. Ju{•la.~lr .~uJ '(d:d ~~ilh ('Irtk ('ircuit ('uurl. anJ JupGcalr Nilh Tax Aa:.cssnt)
:ir~ - soo~ 22fi ~~Mr,~ 1~20
- - - - -
_ _
,
.
~
. . . . _ _