HomeMy WebLinkAbout2249 Declaration of Domicile and Cii~zenship F~
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"I'U'fifl: STATE AND CUUN1'Y TAX ASSL:SSOft, ~~:~94 .
ST. LUCIE ~ ~
_ COUNTY, f~ LORiI)A:
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This is my dcclaration of Uomicilr and Citizrnsl~ip in thc Statc ot Florida that i am filing Ihis day in
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accordancc, and in conforniity with Section 222.17, Florida Statutcs. _
I was formcriy a Icgal resident of r v~S ~ O~ ~ N D 11~ 11~ f~ [
~ (Citr) ' (St.ee) ~ .
resided at QM~S `~R~ ~P . However, I have changed my domicile to
,
(St~eet and Number)
and am and have been a bona fide r~sidsnt of the State of Florida since ~ND day of ~
d(I ,L y , 19~~ and 1 reside at z 3 ~L 1~ ~I Df~ /7 VE~'ut/~'
(Stteet aad NumAer)
~ ~QC~s ~.llC:/cG 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. .
(l~sert here anr pertinent txts, such as sale of pro~+e~tr M business, or relinquishment of employment at tormer
domic~le, removal of fa:aiiy to new domicile, purchue home, rte.)
ENTERING CHILDREN IN SCHOOL: II. HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names:
MAQ~a
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fllf0 e.ti:~ ~tcC~rDED
ST.LUC': _n~fN~AS~A_ ~
Rv"G.: - :
CIEF c :v:' C~URt
crr%- Y-- ..c~y
.lu~ ~a a 4o PM'~~ ~
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c~86994
~ I FURTHER CERTIFY that I will register at my local address when the registration books reupen, and .
comply with all other requirements ef a legal resid'ent of this State. ~
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I FURTHER CERTIFY that [ have no intention to return to my former domicile, and 1 intend to rem:~in in
r- ST. LUCIE ~
/~U,~ ~ /"i~,2C~__ ~ , -County,
Florida, permanently.
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Sworn to ~~Qd~`s~bscril~~tiefore me this day of ~
~ ~ ~ : ~~1 ~ ~l
- ~ i` " ~ - -A.D. 19 74__.
_ , ~ • _ ~T_ , Florida ,
~
_ t • ~ ~ ~
gy ~0 ~ Deputy Clerk
BGOK ~`~9 p~~ 2249
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