HomeMy WebLinkAbout2395 `t ~ i
De~laration of Domicile and Citi~enship ~
~
~
ATC AND COUNTY TAX ASSESSOR, ~9l'~ . ~
TO TtiL• ST 4 ~
$T. LUCIE _COUNTY, FLORIDA: ~ f
~This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in ~
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accordance, and in conforniity,with Section 222.17, Florida Staiutes.
~ ~ T~'N ~s rri) , ~ i't.v / C ~ ~ and 1
I was fo~ erly a le a~ 'den t ~ `,~~~r~ ~s~~~a~
G~
resided at . However, I have changed my domicile to ~
~ (Suett and Number) f
and am and have been a bona fide resident oC the State of Florlda since ~"•'S T day of
~ , 19 and I reside at L' f`~ T~ c~•s~ _
~ Street and Numbe~)
~ Count Florida `
.~G T ~ c r(' c~ ~,~a,, Yr • i
• `a,y, - . ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Floriaa. ~
~ (tnsett here soy perlinent tscts, such u ssle ot propertr or business. or reliaquisAment of employment at former '
domic~e. removsl ot familr to new domicile. putchase oi home. etc.) t
ILDREN IN SCHOOL: HOMESTEAD EXEMPTION: ~
ENTERING CH ~
If entering children in school, r
please list their names:
Ef-~ Nib i i'G C
1
~ st~iuc
e ~'au~ir E~.
fiOiF' -~tt1iAS
CLEF.lC i_::~UIT COU T ~
- Qfr~~tQp •I[r.~r.EO
~uc J+~ 9 Ze AN~'1~!
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I FURTHER CERTIFY that I witl register at my local address when the. registration books reopen, and
comply with aU other requirements of a legal resident of this State. ~
I FURTHER CER Y that 1 have no intention to return to my former domicile, and I intend to remain in
` ST. LUCIE County, ~
,
Florida, permanently.
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Sv~o~njte and,su~s~~,d~hefore me this ~ day of , - t,{ ~<< ~~~~f
_ a . : Cr~ _-~t/~-ti~,_ 1
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_ :,~s; ~ A.D. 19~~~ ~ ~
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- ~ ;~y~ ~ =f-~ ~pII~_ ` ~ ? ~ , I'lorida
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g ~ ~ Deputy Clerk
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