HomeMy WebLinkAbout2766 Decl~ration of Domicile and Citizenship A~ ~ ?
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TO THE STATE ANU COUNTY TAX ASSESSOR, 285148
ST. LUCIE COUNTY, FLORIDA: '
This is my dcclaration of Domicilc and Citizcnship in the State of Florida that 1 am filing this day in
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accordancc, and in conformity with Section 222.17, Florida Statutcs.
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I was formerly a Icgal resident of . , and I •
~ (Citr) (state) .
resided at 3~ ~ ~ ~ 1~Y , ~~~+h . . Howe~er, I have changed my domicile- to ,
~ (Strtet aed Number)
and am and have been a bona fide resident of the State of Florida since -~_:.L-_- day of
M~ r C.r ` 19~ and I reside at ~ ra ~
(SUeet ~d Number)
F
~ Ci ~ lC~ 1 ~ f
l^_____-. County, Florida, ;
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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 pcrtinent facts, such ss sale of propcKty or business, or relinquisAment ot empbymmt at tormet
domic~le, removsl of famitr io new domicJe. purchsse of dome, etc.)
ENTERING CHILDREN IN SCNOOL: n. HOMESTEAD EXEMPTION: ~
If entering children in school, .
please list their names: %~~iuc
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ROCER ?~IT~
CIERK CiFVJI~ C'0lIi0~ ~
R~CQriO YEc~FtEO~~...~ •!~p
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with aU other requirements 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 remain in
7 ~ `-C ~ ST . LUC IE , County,
Florida, permanently.
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~ _`~S~vOtn:bo ari~ ~a~sjb~d before me this day of oQ _ ~d
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_ ' , ~tC'LC~ Florida
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""'~•;-r ea.~-,,.~~.
g~~~~1 ` ~ Deputy Clerk
600K~S PACE~~V~
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