HomeMy WebLinkAbout1754 ~ . . . . . • N ~
Deciarat~on of Domicile and Citizensh~p
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~~U TNE STATE AnU COWTY TAX ASSL:SSOR, ~~y`
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ST. LUCIE COUN1'Y, FLORIUA: ~
'Illis is my dcclaration oi' Uomicile and Citizcnsl~ip in thc State of' i~lorida that 1 am filing Ihis day in
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accorJance, and in conformity ~vith Sectian 222.17, Florida Statutes. ~ !
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I was f~nnerly a fegal resident of ~~~R p~ Li1 , ~and 1 :
(citr) _ (state) : '3
OX /~/S . Hawever, 1 have changed my domicile to 3
resided at
(Street aod Number)
y Ti~I da of ~
and am and have been a bona fide resid~nt of the State of Florida since Y
_•~~J C y , 19~ and I residc at ~ 2 ~ ~ ~ 7 T~~ ~T v
(Street and Number) , ~
~ E~ S t. Luc ie County, Florida,
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(c5ir) :
ai~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of ~~lorida. ' '
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(Inserl here any pertinent lacts, such u sale of property or business, or relinquisAment of employment at former
domicile, remoYal ot family to new domicile, purchase ot home, itc.)
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ENTERiNG CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION:
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If entering children in school,
please list their names:
~~,6FC'C'A L• GE•HA•~/
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L~ A~/D i~E ~o ~E~? Ay ~
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fILfO A4`~ ~ ~ • {
ST. lUC1E =:,O~Ntr flA. ~
ROC~r? =~~T,~A$ ~ , .
ClE?K C+' _~JI~ i,aURT ' -
REf;1'?~ : ~ = r..E:s `
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I FURTHER CERTIFl' that I wifl register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State. #
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I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ E c~ ST . biJCIE County, ~
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Florida, permanently. t~~~r)
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_ ~ p • SIG~IATtJRE
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Sworn. to and
~ubsc ~before me this ~ day of . ;
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" 74
~ A.D. 19 ~
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~ ROGER" ~~RAS, CLERK CIRCUI-T COURT , Florida ~
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~ gY ~ Deputy Clerk ~
- xecuted in du IKate and origin-rl fded with Clerk Circuit Court. ond duplicate with Tax Assessot)
' (To be e P .
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s~~~0 P~~1753 A~:«
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