HomeMy WebLinkAbout0449 ~leclaration of Domicile and Citizensn~Q {
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TU Ttl~ STATE AND COUNTY TAX ASSL:SSOR, `
ST. LUCIE _ CpUNTY, FLORIDA:
71?is is my declaration of Domicilc and Citizcnship in thc Statc of Florida that 1 am feling this day in
accordancc, and in conformity with Section 222.17, Florida Statut~s.
l~ rl ~C. ~ , ~~!//I4/S and 1 ~ .
I was formerly a lcgal resident of _ ~ ~~i1e~ E
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resided at -~S ~O ~0. F~E~ (d . However, [ have changed my domicife to
. (Street aod Numbe~) ~
r~J day of ~ ~
and am and have bcen a bona fide resident of the State of Florida since !
• 3~ si3 - ~
e ~ , 19~ and 1 reside at S~K~ Number) •
r~ ~ I e~?" ~ Q S~ ~ fi G f~- County, Florida, ;
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~ (citr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State ,
of Florida. ny y~ s~o y`h ~ f~ ~ v~- a+•r~e y~-e ~ t 66~ S'~ ~uG ~e C Z~ ~
s h, nK o a d ~d~ ~e ~
~ (Inse~t here anr pertiaent tacts, such as sale ot propertv ot business: or reliaquisAment of emplorment at formet ~
domic~le, temoval ot familr to new domicile, purchase of hume. etc.) ;
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION:
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If entering children in school,
pleas~ list their names:
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I FURTHER CER1'1FY that t will register at my local address whcn th~ registration books reopen, and
comply with all ott?er 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,
~C /Jr ~S'C~/d ~vh+e /leay /Corf ~/i~-r~e - ,
Florida, permanentiy. . t:-~~r~
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$W~D ~ 20iA~ SU tbc,s~`
b.e~~tore me this ~ day of ~q.,[ ~ Q x S-- / 3
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,~:.~~4.'~' - A.D.19 74 _
• ~~%y / Florida
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: -~t{ ~{~_G~..,~~`' ~
gy L puty Clerk ~
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