HomeMy WebLinkAbout0198 ?
Deciarat~on of a~rnicile and C~tize~ship
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TO TNE STATI: ANU COI.~NTY TAX /1SSL=.SSOtt,
ST. LUCIE _ ~UNTY, FLORlDA: '
This is m circlar::tion of Domicile and Citizcnship in ihc Statc of Florida that 1 am Cling this day in ~
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accordancc, and in conforn~ity witi~ Section ''2.17, Florida Statutes. ~
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1 was fotmcrly a lc~al residcnt•of and I ~
1 (Cit / ~ (Sule)
resided at . However, I have changed mv domicile to
~su~e~ .~a N ee.) :
and am and have been a bona fide resident of the State of Florida since day of ~
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, 19~,ZSf., and 1 reside at ~t
/ l~ 1~Z'G~ ~
' l ` (Street aad Number)
~ o - County, Florida, ~
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an~+ this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(I~ert here anr pertinent tscu, such as sale of properqr ot business, or telinquishment ot employmmt at tormer
domie8e. rcmovaf of family to new domicile, purehsse of home. etc.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
pleas Iist their n - .
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~ St.ll1G:~ _Ot~NT`.' FIA. . '
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~ - C!E' ~ :~~T ~GURT . ~
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~ Auc ~i 12 25 PN'~~ ~Lb _ .
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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. . E{
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I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ . o~~ _ ST . LUC IE , County,
Fiorida, permanently.
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Swc~rn to and su~sc~ibe~ b~fase me this day of ~
. . ~ y ~ ~ F~
A.D.-19~. _ ; /
. ~S
ROGER P ~ _ ~.IIIT_C~
l~T ~-,-//`f~ ~:~.t' , I'lorida ~3
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B Deputy Clerk ~ ~
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