HomeMy WebLinkAbout2343 D~clara~tion Qf Qomicile and Citizer~sfiip
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7'U Ttll: STA"I't: ANI) CUUNTY TAX ASSGSSOR,
`ST. LUCIE COLINTY, f'LORIDA:
This is my dcclaration of Uomicilc and Citir.cnship in ihe Statc af florida that t am filing this day in
acconlance, and in conformity with Sectian 222.17, Fiorida Statutes.
1 was formerly a lebal residcnt of ~v r~v ~/~"~~'~Z ,~G~eZ!/e - and I
~ (ci~r1 (sa~e)
residcd at _ ~z Cd/ C .~iowever, I have changcd my domicite to
(Siteet snd Num D
and am and have becn a bona Gde nsident of thc State of Florida since Q- day of
L! l,rS~ , 19.,~~- and I residc at ~ ~O
(street ana jVumber)
f~'t ~L'~~ . L ~rc r e Coun~y, Flor;da,
.
- cc;~r~ .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(I~ser1 Aere any pcrtinent facts, such ss sale ot ptoperty or business, or retinquishment ot employment at former
domic~e. remorsl of family to new domicile. purchase ot home. etc.) -
N HILDREN IN SCNOOL: NOMESTEAD EXEMPTION: ~ '
ENTERI. G C ~
If entering children in school,
please list their names: -
!,~%~a•~ _ ~a~lor~ e~ _
~~39~ 41 -
~?~f : : ' = =~~::KDEO
Sj.IU~' ~ :.:':~.T`! FLA.
fiv~~. •I~AS
' C;':.. - t• ;~URT 1
f r _ 'n
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~ Auc i3 I i6 ~M'7~
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with ali other reyuirements of a legal resident of this State.
I FURTHER CCRTIFY that 1 have no intcntion to return to my former domicile, and I intend to remain in
Lu~l~ ST. LUCIE , County,
Florida, permanently.
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, - ~i10C K- C~OUY'~
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Sworn; fo and su$s~rl~ed betore me this ~3 day of
~ ~ L~ ~ A. D. 19~4~ ,
~ f~ ~s~t e , Florida
ROGER ITRAS~RK c?R_~t~
C.DIIgT.-
:
By ~t-~-~-e-- ~dz Deputy Clerk
' d00K ~W PAbI ~V~
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