HomeMy WebLinkAbout2715 Declaration of Domicile and Citizenship
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TO THE? STAT~ ANU C'UUN'1'Y 7'AX ASSL.SSOIt,
ST. LUCIE CpUN1'Y, FLURIDA:
Tl~is is my dcclaration of l)omicile and Citizcnship in the Statc of Florida that ! am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes. ~
1 was formerly a legal resident of ~~A E'~'~ and I
_ (Citr) (State)
resided at ~ S/`~ A ~ . However, I have changed my domicile to
(Street and mbe~)
and am and have been a bona fide resident of the State of Florida since ~ day of
, 19~y and I residc at ~~S E 1 U 6
. (Su t s~d Number)
~ ~ v e I~c' , ~ U C' County, Florida,
(c:~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert hcre sny {+erlinent facts, such u sale of property or business, oc rclinquishment ot cmployment st tormet
domicile. tcmoval ot family t2 new domicile, purchase ot home, etc.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: a
If entering children in school, _
please list their names : 2~~~8~
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I FEIRTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with all other requirements of a legai resident of this State. _
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ~7- S ~ ~y i ~ ST . LUC IE , County,
~ Florida, permanently. «'`r~
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3.worn to and subscri~ed before me this ~G day ot
~ ~~i 1= f
~t. ~ A.D. 19 74 r
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~:K , . , ~ .
~ __ROGER P T. A~~~LERK
~IR~U.IT_~QiIBZ_ , Florida
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~ By a~/~. ~Y c~- Deputy Clerk {
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~ ~~30 ~2'~~4 - ~X
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