HomeMy WebLinkAbout0568 ~4Z71a71~ ' Gf ~
Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSCSSOR,
ST. LUCIB ~pUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordanc:e, and in ~~,~f~rmity v~rith ~ction 222.17, Flflr~!9 ct?t+~t~s,
1 was formerly a legal resident of `~f "1~"-uh~'~'~ i , • and I
(cur) (st•u)
'resided at ~ ~ - ~ ~ . However, I have changed my 'domicile to .
(saes~ .ea mbe~) 1,~,
and am and have been a bona ~de resident of the State of Florida since day of
, 19! L, and I reside at v `
(sar.et .ad Irumee~)
~7 ~ 5~~~, _ St . Luc f e County, Florida,
(~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnsert here anr pertinent faets. such as sale at P~oPK~Y a~~~• a«<~°Quishment ot employment at iormer
domic~le. removsl of familr to new domicJe. purchase of home. etc.) ~
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION:
If entering children in school,
please list their,names:
~ ~ Q
~o..~.,`.. ~Y'\C.t
fKfO ~?i10 ltECOROE~
ROCf T~~lrtTMS u
' CtfRK Ci?CDR COi1RT V
RfCGR7 VERtF~Fp
l 4 '
N~r i9 PM 1~!
~8151'7
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
~ 1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend~to remain in
ST. LUCIE County,
• - . ,
Florida, permaner~tly.
.,~U;~ il~l, ~ ~
. ~/~~,.,,,~R yoN ~a.bo?•s
. SIGNATURE
~ iJ' ~ !
~ , .
' • _ ~ t' , ~
' t.~ ur
• ~ , • : i ~i'
Swori~,tti:an , sub~¢ri}~td~i~efore me this day of
r~ ~ . r'=;' A.D. 19 74 ~ d - ~ ~
- - r
:
R~ ~~wR.. ~Q~~RK CIRCUIT COURT ~ , , Florida
::r' ~
~
~t1.i~~~t`,sC~,~
gy : t:,. puty Clerk SOOK~~~PAGE
(To be e: ted in duplicate snd oriRinal fiied with Cletk Citcuil Court, and dupliesle with Tsx Assesso~)
_ - - -
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