HomeMy WebLinkAbout2869 ~ • f ~ ~ ~ \ /
Declara~ion of Domicile and Citizenship
.
TO THC STATE ANU COUNTY TAX ASS~SSOR, ii~S1.O
ST, L~CiE ~puN rY, FLORIDA:
This is my declaration oC Domicilc and Citizcnship in thc State of Florida that I am filir?g this day in
accordance, and in conformity_with Section 222.17, Florida Statutes. ~
I was formerly n legal resident of ~ Q~~ s~l4-~s~--~~--- ~ ~ ~ and 1
(citr) (st.te)
resided at s . Howcvcr, I have changed my domicile to
(Suest and Numbet)
and am and have been a bona fide resident of the State of Florida ~ince ' day of
, 19,_, and 1 reside at s~~~ -
. (Street ~nd Numbet)
4 1 yv- ~--~A County, Florida,
~-~-~-1~~ , .
(a~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ,
(Inse~t he~e a~r pettinent facts, sutA as sak of ptopetty or businas, or relinquishmeat of emplorment at torma
domiele. removal of fsmiir to new domicile. purcAre ot bome, ete.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
-If entering children in school,
please list their names:
i
- ~
. i1LEP l.~ti k~C3~:DE~ 11. .
fT.~W.~~ GGci117T F1A.
~;{~~L~; r 3~~5 ~
CtE~r: C.=~rJ~T COilRT
~ A~co1t~ ~f;~r~fo
. _ ~ ~a 4s~+~7~
~
; .
~ .
~
~
~
289510
,
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~~~~~QC~~~~~~ ~ ~ ST. LUCIE , County,
Fiorida, permanently. ~a~r~
~ ~
~
~t
~ -
~
Swo ~ and subscribe~efore me this day of .
. . ~l/ ~ -S. ~ a,
QUCUST , _ _ . ~ A.D. 19_Z4_~ ~
= , Florida
.~n~,~' ~,~,r
- - - .
- -
- .
` A~ ~C~. i~~
puty Clerk
; ,
, . .
. =
: f~_ ~ i•~~ ~ t ~ ~ Q
~ • ~ • ~ ~ PACE
~a, : ~ y : ' . 600K
~ ~
. .
N..••••~~•
Q~ ~ i:
" n~ .
_ , . _ - - - - - _
_ _ ~
2 ~ 3 _ _ J..~ ~ a ~ p. '~Y
.3., a... a v .f.~.__.._ r~r. _ a_ . _ _ ,+°'s..~'_'fi .~s€ .