HomeMy WebLinkAbout1090 ~~31919
Deciaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpV~y, FLORIDA: .
This is my declaration of Domicile and Citizcnship in the State of Florida that l am filing this day in
accord'ance, and in conformity with Section 222.17, Fiorida Statutes.
~ ~ ~ C ~ ~ /J and 1
I was formerly a legal resident of ~ rR ` F •
(Citr) (Stste)
resided at ~30 I~~~~~v~Z However, I have anged my domicile to
tsa~~ .aa N~~e«) ~
and am and have been a bona fide resident of the State of Florida since _ day of
~ _ .~'s
/1'J ~/2 , 19~.~ and 1 reside at ~ C ~ ~ ~ .
(Stceet ~ad Numbet)
~ ~ L u ~ / ~ St. Lucie County, Florida,
~a~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
~
(i~ert here snr patinent fscts. sueh a sale ot propMlr or business• or ~elinquishment ot e~eploYmeut ~t totmet
domie~e. temoval of haulr to new domicile, purchase ot dome. cte.) ~
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION:
If entering children in school,
please list their names:
f LEO ANO RECORpEp
. f~. LUCIE COUNZY FIA. ~
_ ROCER ?01TRAS
CIERK CI~~CUIT COURT
RFCnRO Vf~~Flf.O
~ Miur t3 9 4z ~M'7~1
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~
~
~ - ~ ~8'~ 9~9
I FURTHER CERTIFY that I will regist~r at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
. _ ;
~~~~!,t,~ R CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
•;-~J
f'~ ~ ~ ~r. i~T C~ C1 C~ E ST • Z.UCi~+' ~ COUi1t~l
~ - ~ - . ~
• ; . ; ~ali~i (c~ir)
y':t ~ . i • m . _
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. . . ' ~ - S IG ATURE
Sworn to and subscribed~fore me this l day of / ~ ~
74 ~~/,~t c h? ~?~9 N-c~ ~4 E
A.D. 19 • --Ff~'fI'i~ig "A r ss -
RpG~ER POIT S, ~~ERK IRCUIT COURT S~.~vC , Florida
gy Deputy Clerk g~ ~10~ :
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(To be ex c ted in duplic~te and oriainal t'ded with Clerk Citcuit Court, snd duplicate with Taz Asse~sor)
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