HomeMy WebLinkAbout2919 • ' ' itizenshi ~ ~~4
Declarat~on of Dom~c~le and C p
TO THE STATE AND COUNTY TAX ASSESSOR, ;~~~~164
ST. LUCIE CpU~Y,~FLORIDA:
'il~is is my dcclaration of Domicile and Citizenship in the State of Florida that 1 am Gling this day in
accordance, and in conformity with Section 222.17, Florida Statutes. ~
I was formerly a legal resident of LON /~a~r C~OLp~PA~C~ and l ~ ~
~ tci:r) (st.t•)
resided at ~~9 ~/~L~~ . However, I have changed my domicile to
(Street sad NumAer) TN
and am and have been a bona fide resident of the State of Florida since ~ day of
f~i y , 19~ and I reside at -r?/~~r~/~ '~7'~ -
- (Sireet and Number)
L ve ~ E _~'r L~/C' ~ F County, Florida,
(cier)
and this statement is to be taken as my declaration of citizenship, act~.al legal residence and domicile in the State
of Florida.
(lasett here snr perlinent fscts. such as sale ot property or business. or relinquishment ot employment ~t former
domic~le. temoval ot fsmilr to new domicite. purehase ot home, etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: a
If entering children in school, _
please list their names:
~ArN ~~e~~? E- ~9~/~? ~N~m~-~
f ~E~ ANO RECOROEp
S~ ROC R pp
T T1' F~~, ~
RE oAORyER ciEO ~ URT ~
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I FURTHER CERTIFY that I will register at my locai address when the registration books reopen, and
comply with aU other reyuirements of a legai resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ S~ L ~'C . ST . LUCIE , County,
Flori~;pe. ntl . cc~~r)
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Sworr~~toend'subscribed before me this ~ day of ~
~(~l Ov.~ _ _ A.D. 19 74
_
ROGER POITRAS,__,~LE$K CIRCUIT CaL1R~ , Florida
gy Deputy Clerk
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~ 7 PAGE~~
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