HomeMy WebLinkAbout0769 Declaration of Domicile and Citizenship ~ i
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"ro Tlit: STnTL' AND COUNTY TAX ASSL'SSOR, '~~SS~.`~,~0
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ST. LUCIE COUNTY, FLORIUA:
This is my dcciar~tion of Domicilc and Citizcnship in the Statc of Florida that l am filing this day in ,
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accordancc, and in conCormity with Section 222. i 7. Flo ' Statutes. ~
1 was formerly a legal 'dent of , ~ and I '
(Citr) tstatc) i
resided at ~ ` - . However, I have changed my domicile to
(Street ~nd Number) i
~m and have bcen a bona fide resident o[ the State of Florida since day of =
and a ~
~ , 19. S~, and 1 reside at 7f0 ~~Ir"~"'~`'~.eC~'`.'t ~~f~"~`
(sacec and Numbcr) ~
~ ~ _ ~f~c County, Florida, ,
J 1.C~ }
(Citr)
and this statement is to be taken as my decfaration of citizenship, actual legal residence and domicile in the State
of Florida.
(insert here sny pertinent fxts, such as sale ot propertY or business, or ~elinquishmeat of emplorment ~t formet
domit~7e, remorsl ot (smily to ntw domicile, purchase ut home. etc.)
ENTERING CHILDREN IN SCHOOL: Q HOMCSTEA~ ~X~MPTION: ~
If entering children in school,
please list their names : ~~o A~r ~~~~~~~p
st_wc~~ cauwrr Fu?.
aoc~~ ~ ~~;~,?s
~ifRK ~ a. c ~a1 ~auaT
afci~~~•~~~~.' ~a
3 ~O 55 AIt?' 1~
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I FURTHER CERTIFY that I will register at my local address when the rcgistration books reo~en, and
cumply 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
~-T-~__ ~ { ST. LUCIE , County,
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Florida, permanently. -
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SKc}i~" to d subscri~ before me this day of
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~ A. D. 19~-. •
~ `~f, "?~~r_ JJ.~,, ~ Florida
R~
gy ( puty Clerk
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