HomeMy WebLinkAbout2696 . ~ i
Declar~tion of Domicile and Citizenship
TO TtiE STATE AND COUNTY TAX ASSCSSOR, ,`~~~JL~ :
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ST. LUCIE CpU~y~ FLORIDA: ~
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'Ihis is my declamtion of Domicile and Citizenship in the Statc of Florida that I am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
I was Cormeriy a legal resident of =A~.,~C . , • and I
(~yir) (sc,ee)
resided at ~
r~ 0~~ , - . However, l~ve changed my 'domicile to
csu~ ~.a Nd~eK)
and am and have been a bona fide resident of the State of Florida since 3 ~ day of
~,V ~ - n ,ri ~ v 3
/`f~lj~~f , 19~~ and I reside at ~ 1
(Street and Number) ~
/ f~~~ _ St. Lucie County, Florida, ~
(ca~~)
and this statement i~ to be taken as my declaration of citizenship, actual legal residence and domicile in the State ~
of Florida. ~
~
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~wY per~ineat (scts, cuci~ as sale of ptoperty or business, or relinquishment oi emplorment ~t fo~mer
do~icie. teoo+al oi tsmilr to ncw domicilt. Purchzse ot home, etc.)
. HOMESTEAD EXEMPTION: ~
ENTERIPIG CHILDREN IN SCHOOL. ~ ;
If entering children in school, ~
please list their,names: ~ }
~
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Fi~EO,?NO aECOR~EO ~ ~
f , sT. ~uciE covNTr
~ aocEa FoizR~?s
CLERK CsRCU1? COURT ;
€ RECORD y~F~~~EO..r--- =
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~ I FLJRTHER CERTIFY that I will register at my local address when the registration books reopen, and ~
~ comply with aU other mquirements 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 rcmain in ~
~ F
1: .
Y' • ST . LUCIE ~
~,~T /~iPl E _ , County, F
D
Florida, permanently. (c~~r)
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~7'v,~,~rs~
-SIGNATURE ~
•,`~R~R~ ',i~y~~~ L/'~ ~
~S~rh to ~ ~'bed before me this ~ day of ~
~ - s _ ~ ' ~ "a _ 74 9' ON/ T/? ~ % ~
- .Q~ - _ A.D. i9 ~ Ting ress {
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p`~ '~~R-`~;. CLERK IRCUIT COURT ~~T~~,P~_, Florida ~
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"By. . , . , Deputy Clerk n R ~
g=F ao~~226 pa~~~`f~4
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_ (To be eaec~ted in dupLcsie snd ~riE~eai fdrd with Clrrk CircuN Court, and duplicate with Tat Assessot) ~
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