HomeMy WebLinkAbout2995 .
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' i i! and Citizenshi ~ ~ ~
Declaration of Dom c e p
:
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7'O TtIC STATE AND COUNTY TAX ASSI:SSOR,
ST. LUCIE ~~15 ` ~
_ _ COUNTY, CLORIUA: . . ; ~
This is my dcclaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in ~
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accordance, and in conformity with Sectio~ 222.17, Florida Statutes. . ~ ~
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I was formerly a legal resident.of ~ ~ ~ • ~ • , • and I
(Citr) lStaee) >
resided at a~ C~ . Howcver, 1 have changed my domicile to
(Sircei and Number)
and am and have been a bona fide msident of the State of Florida since ~ day of ~
/ .
J' , 19Z~ and 1 reside at
. ~ ~ (Strat and Numbet)
_ ~Q ~ P , ~ L' ~ , u e ~ ~ County, Florida,
(c~cy) ; ,
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(insert here sny pertine~t tacts, such as sale of propertr or Dusiness, or telinquisAment ot employmeat ~t totmer
domicle, removal oi familr to new domicJe. purchase ot Aome. ete.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: ~ .
If entering children in school, `
please list their names:
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~~9-f~ e r ~~/11,~ K/U/'L~~ - - t'
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with aU other requirements Qf 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
~ ~ ~ ' ~ N C ~ ~ . , ST . LUC IE , County,
Fiorida, permanently.
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Swarrijxo`~an~~siibscli
~h"~~~ore me this --2 d day of
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~ ' + 9 ' ' ' ~ A.D. 19~4___. ~
~ : , • '
R r~~~, CUIT cQ11RT , Florida
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By , ~ ~ • Q puty Clerk ~ ~
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~ goox 2~0 Fac~ 2~4 i
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