HomeMy WebLinkAbout0217 f-
Declaration of QQmiciie and ~~tizenship
~rc~ 1~ji~ sTn1'l: ANU CUUNTY „~x nss~:ssoK, 2,~~.~?7
ST. LUCIE ,_„COUN1'Y, l=1.ORIUA: '
Tt~is is my clcclar~tion of Domicile and Citizenship in ihe Statc of Florida that I am filing this day in ;
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accordancc, and in cc*nformity with Section 222.17, Flonda Stalutes. . s
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1 was fonnerly a legal resident.of . N'-~~~~~~ 1
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rtsidcd at 1~' '«~3 . Howcvcr, 1 have changed my domicil~ to ~
(Sireet and Number) t
;,nd am and have becn a bona fide resident of the State of Florida since ~ day of
Cc- t , 19~-, and I reside at ~~0~ a->~~ ~o-a ~
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~ c~.z. - County, Florida,
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a»d this statement is ta be taken as my declaration of citizensl~;~actual legal residence and domicile in the State
of Florida. ~ '
(Insert here anr pertinent fxts, such as saic of p~operty or business. or relinquishment ot employment st foroser
domiele. removal ot famity to new domicJe, purchase oi home. etc.)
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ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~ ;
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If entering children in school, - ~
please list their names: ~
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I FURTHER CERTIFY that I will register at my loca! address when the registration books reopen, and
comply with all other requirements of a legal residerit of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in ~
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~Ll ~~U`~, ~ ST. LUCIE , County, Y
Florida, permanend,y. (~"r) '
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~~~vorrrto and:s~bsrribed before rne this . y ~f~ ~
L'ct~.~LC-G A.D. 19~_ ~ ~~c.a~~ ~ T
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ROGER ~ G~~ , Florida ~
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By / ~vc'~ l~Deputy Clerk '
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