HomeMy WebLinkAbout1786 Declaration of Damicite and Citizenship
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'1'O 7'ills STATG ANU COUNTY TAX ASSESSOR, ~.~~5?72 •
ST. LuCiE covN~~v, r•~oKiuA:
This is my drelaration ot Domicilc and Citizenship in thc State of Ftorida that 1 am filing this day in
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accordance, and in conformity with Seetion 222.17, F[orida Statutes.
1 was formcriy a Icgal resident of T , I~-~'{M'e~/s and I -
(c.tiir) (sace) i
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resided at _ . However, 1 have changed my domicile to
(Street and Numbet) ~
and am and have bcen a bona fide resident of thc State of Ftorida since T~ day of
_ ~/L!N~' , 19,~~, and I reside at 3~~ ~ ~S?~?
(Suett and Num4er)
p1L?" ~.,~T ~u~~~ , ,.5~ ~u~/~" County, Florida, i
(Ci~r)
and this statement is to be taken as my declaration of citizenship, actual iegal residence and domicile in the State
of Florida.
(~eyert Aere anr pettine~t (xb, such as sale ot property or eusiness, or relinquishment ot employmeat at tormer
domicile. ~ea?oval oi family ~o new domicile, purchase ~t home, etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTIONi
If entering children in school,
please list their names:
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F~z~o r.H~ wc::v~o~o d,
sL ~ucrc cu~,~~tr FL~
6Go~= ~ ~~'T811S t
c~E~.~ ~ousr
P.f^••".•=' 7i:.-~r~. ~
~t.1~ 3 O1 PN'7~I
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I FURTHER CERTIFY that I will register at my Zocal address.when the registration books reopen, and -
~omply with all other requirements ef a legal resid'ent of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ~ ~ u ~,`s ST . LUC IE , ' Count ~ L
~ Y,
~ ~lorida, permanenily. } ;
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~ . ,~~"ha. ~~S ~ d e 7; SKi%YKF~J -
Sworn'.to~A~ sitbscri_lfed before me this ~ day of . -
• _ ~ J . ~i?T•~ / T~4 /~~s'T '
" " - A.D. 19_~~ ? ~
: . . ~ r'' ~ UIZ~OIIBT-_ ~oy¢T ~T ~CLlGIc , Florida
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g~•~ g ~ ~ ~ ~ ~ Deputy Clerk =
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6001( 229 PA~E ~7pV F
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