HomeMy WebLinkAbout1634 Declaration of Domicile and Citizenship
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'fU 7~lIL STATE ANU COUNTY ~'AX ASSI~SSOR.
ST. LUCIE
COUNTY, ~LORIDA:
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Tliis is my dcclaratio~i of Domicilc and Citizcnship in thc Statc of Florida that I am Cling this day in
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.~crordancc, and in conformity with Scction 222.17, Florida Statutcs.
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1 was formerly a legal resident of ' ` ~ ~5,,,~~ t{
(citr) '
However, I liave changed my domicile to ~
i is i7i~w~ 'l~Z~
rrsidcd at -y~.~ ;
Sireet and Numbe~) G~v : ~
and am and have bcen a bona lidt resident of the State of Florida since ~ day of ~
, 19_1~
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- and 1 residc at ~ ~ ~"`'l' ~
~ (Street snd umber) ' ~
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St . Lucie County, Florida,
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(C~ty)
and this statement is to be taken as my declaration of citizensliip, actual legal residence and domicile in the State ~
~f Florida. `
here an rtinent facts, sucA u salr ot property or Ausincss, ot relinquishment of employmrnt at former .
(Insert Y : ~
domiciie. removal ot family !o new domicilr, purchase ot home, etc.)
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F.NTE R I N G C
H I L
D R
E N I N S C H O O L: tiOMESTEAD EXEMPTION: {
school ~
If entering children in , ;
please list their names:
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f1LE0 Rh: »EC~RUEO -
5T. WC~£ : ~JltTY FLA.
RQi,~F ?CITRAS ~
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with all other requirements of a legai resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in ~
ST. LUCIE County,
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Florida, petmancntly. ccnr) .
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~ ' ` . c ~ ~ S IGNATURE ~
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~ s~drtfi~ed before me this day of ~
~ S~voiri tO:~~~s~d~ ~ - i
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A.D. 19 74 ~.~_s~ n re s~~ E
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~ ROGER POI S, C RK CIRCUIT COURT , Florida
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_ g ~ ` Deputy Clerk ~a
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(To be executed in duplicale and origin~l fded with Cierk CitcuA Court, snd duplicate v?ith Tsx Assessor) ~
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