HomeMy WebLinkAbout1710 Deciaration of Domicile and Citizenship t~:
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"CO TtiE STATE AND COUNTY TAX ASSL:SSOR,
ST . LUCIE 2~~~9 ~ `
- _ COUNTY, FI.nRInA: }
This is my dcclaration af Domicilc and Citizcnship in thc Statc of Florida tliat [ am filing this day in
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accoraance, and in conformity witli Scction 2~2.17, Florida Statut~s. ;
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1 was fom~erly a lrgal resident of l1~1~-~0 and I
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r~sidrd at ~v~FL~-~~----~~v~'8 ~ 4. ~o'~~~. However, I have changed my domicile to r~
(Street and Number)
and am and have be~:n a bona fidc residcnt of the State of Flocida since ~ day of
19 7~, and I reside at Rm S~''`~~L.~ • .
• (Strest and Number)
St . Lucie County, Florida, ~
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(C~ty )
and this statement is to be taken as my declaration of citizen~hip, actual legal residence and domicile in the State ~
of Florida. ~ ~
(Insert hc~e aoY I+ertinent fxts, such as sale of property or business, or relinquishment of employment at tormer F t
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domic~lr, eemoval oi family to new domicite, purchsse uf home, etc.) ~
ENTERING CHILDREN IN SCHOOL: x HOr~STEAD EXEMPTION: _
If entering children in school, ~ ~
please list their names: ~
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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 legal resident of this State. -
I FURTHER CERTIFY that I have no intention to retum to my former domicile, and I intend to remain in
Ta R T I~~~F R~ l' ST . LUCIE County,
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~ Florida, pernianently.
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~ Styo~ TQ alnd 'su1~,~i ~iefore me this day of
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~ + . ' A.D. 19 ng re ;
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- gpt'# ~~S~ CIE K CI RCU IT COURT ~ QT f'i ~.e C,~ , Florida ;
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g s . I
gy ~r~, Deputy Clerk ~
(To e:ecuted in duplicste and ori~Cinal fJed with Clerk Circup Courl, and duplicate with Tax Assessor)
E~~ ~ ~~K230 ~1749
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