HomeMy WebLinkAbout2134 Dectaration of Domicite and ~itizenship
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"f0 TIiE STATE ANU COUNTY TAX ASSESSOR,
_ ST. LUCIE _ CpUNTY, ~LORIDA: .
This is my drelaration of Domicilc a~d Citizcnship in the State of Fiorida that 1 am filing this day in
accordancc, and in conformity witli Scction 222.17, Florida Statutes.
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1 was formerly a legal resident of n p e , ~ and 1
, l (Cltr) (Slate)
residcd at .~`~b~,._..~ l~~ S~~- , l iowevcr, I have changed my domicile to
(Streei snd NumDer)
and am and have been a bona ~de resident of thc State of Fiorida since ~ day of
\ , 19 and I reside at ~ a- ~ a J~• l
~ (Street sad Numba~)
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u~,~' ~ 1_ , County, Florida,
(atr)
and this statement is to be taken as my dcclaration of citizenship, actual legal residence and domicile in the State
o€ Florida.
(insert here aay pertinent facts, such u sak o[ pcopertr or ~usiness. or rellnquisAment ot employmeot at iormer
danic8e, removsi ot family to new domicde, purcha:e ot home. etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEriPTION: ~
If entering children in school,
please list their names: ~~~4~,
fi~EO n~ic~ R~co~DEO
st. ~ucs: covHrr Ft~.
~ ' ~ RC~c n. r,.
' ' CLERK L' ;CU~jRAS
~ ' 4Er,04~ 'vf c , ~ COUAt
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. a~c I1 4 34 PH'1~I _
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
cotnply with all other requirements of a legal resi8ent of this State.
1 FURTHER CERTIFY that I have no intention to return to my former damicile, and I intend to remain in
~ LUCIE
~ - ,~c~.~c...C~ _y • County,
Floric~a„}~er~qal)endy (c"r) °
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3vydrij ~,~,~ri~~is~ribed before me this day of
F.ai
L A.D. 19 7__4___.
ROGER POITRAS C.F K CIR .UIT CO 1R , Florida
- By ta
~ ~n~~~~CNeputy Clerk .
' ;~IC ~?eN i#~E~~~
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