HomeMy WebLinkAbout0237 Decfaration of Dom'rcii~ and C:~tizensn~p '
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~~o T~il: STAT1: AnU ('UUnTY TAX ASSI:SSOR, ~~~~~2
ST. LUCIE k~
_ COUNTY, FLORlUA:
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'tl~is is my dcclaration of Domicilc and Citizenship in thc Statc vf Hlorida th~t l am fiting ihis day in
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accordance, and in conformity with Section 22?.17, Florida Statutes.
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t was formerly a Iegal resident of ~l •G v and 1 ~
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;esided at !
t_ -r ~'j~ . However, I have changed my domicile to
(Street snd Numbe~)
and am and have been a bona fidc resident of the State of Florida since S day of ;
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_ ~'~c~,i.c ~ , 19~-, and 1 reside at L~'E S ~
(Stteet and NumEer)
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-'a ~,T r~c c-c , ~ ~ <<c_~-~ County, Florida, ,
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State
of Florida.
(Insert here any prrtinent facts, such u sale of propertr ex Dusiness, o? relinquishment of cmploY~ueni at tormer
domicile, remoral ot (amily to new domicite, purchase uf Aome, etc:)
ENTERI*tG CHILDREN Itd SCHOOL: Q HOMCSTEAD EY~M:'TION:
If entering children in school, ~s
please list their names: FI~EO AhD RECOR~ED ~
ST. ~UCIE COUKTY FIA.
ROCtF °6?TRAS j
~ CIERK CtRCU1T COURT
REC:?FO Y£?+FIEO
Ju~ Zl I s~ PN'1~1
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1 FURTHER CERTIFY that 1 will reg~ster at my local address when the registration books reopen, and
comply with all other requirements ef 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
ST. LUCIE , County,
Fiorida, permanently. tc~tr)
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; Swo,rr,r t~" ~sufrsc.~IfiCd~efore me this day of _
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- ,n.'~~ ~~i - A.D. 19~~_. V
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gy ~ ~i puty Clerk _
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