HomeMy WebLinkAbout0232 Deciarationvo`~.~Domici~e and Citizensh~p F s~ '
. ,
7'O TtiE STA7'E ANU COUNTY TAX ASSESSOR, 2~O3~U
ST. LUCIE COUNTY, FLORIDA: ~
'lliis is my dcclaration of Domicilc and Citizc~~sl~ip in the State of Florida tl~at I am filing this day in
accordancc, and in conformity with Se~tion 222.17 Florida Statutes. f
l was formcrly a Icgal resident of • o~ y~ and 1
, . (City) ~ (sc e)
resid~d at L-~_
~ T.g ~ . However, 1 have changed my domicile to
(Street and NumEer) t~'
and am and have bccn a bona fide residcnt of tlie State of Florida since day of ~
~ _ ~ t/.~~ 3~ ~h . ~~r-~ `
- , 19
73_._., and 1 reside a oieE
. (Street and Number)
~F,~..~.~ . ' St . Lucie County, Florida,
(Ci~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 facts, such ss sale of property or business. or relinquishment o[ employment at formet
domicJe. remoral of family to new domicile, purchase of Aome. etc.) ~
• • HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN SCHOOL. ~
If entering children in school,
please list their names:
t
it
t
- z8o~39~
iL
~U01~ C4U£I~TY 1~~~~
' OOER POtTR1~
p~~~R ~~~CUtt COURf
_ RECQ ~ YE~:?'IE4.,.,,,,~.,.~ ~
~~F~ ~ RQ ~
FILEO AND RE~Q ~0 ~ ~ ~ ~
fq,~UC1E C01iN~ t~(1 ~
RdCEN R~~~RAS ~ i`
, c~E~~ c~~cu=~ c~~~
RECORO VER~FIEO ,
~ 3 2 , 36 PM'Z~
~
~ 1~~. - ~
?.5~~'7 .
(THIS INSTRUI~NT is re-recorded to show the~last name as being
Gay (not Say))
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of ~ 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
~ ~ E ST . LUCIE County,
~ ~ - - '
Florid~, per~ientiy. cc~~r)
J,~~• `J~;~~
i
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~ " .
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- :
- S IGI~ATURE
• . .
~ . . r~ . .
,Sworrrf~can~,~s~clbscribed before me this.~~ day of ,
• , 74 ;
A.D.19 `
- i ing ress
P.OGCR POITRAS, CLERK CIRCUIT COURT , Florida
~
n ~c~,~~ Deputy Clerk '
Y
(Tu be executed in duplicatr anJ ori~;inrl fii. d with C)ctk Circuil Court, and dupli~ate wilh Tax As.xssor)
sooK 227 ~ 231 2~6 ~A~ 1~2~
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