HomeMy WebLinkAbout0256 . a
i
Declaration of Damicile and ~itizenship
TU TII~ STATC ANU COUh7'Y TAX ASSt:SSOR, ,`2$~~3 ~ ~
ST. LUCIC _ L~p~~NTY. FLORIDA: -
~ +
~
'Iliis is my dcclaration of Domicilc and Citizcnship in thc Statc of Florida that 1 am filin~ this day in
. , , ~
accordanee, a~id ':n confonniry with S~ction 222.17~ Florida Statutcs. ~
' '
j ~
1 was fonncrly a lcgal resident•oC ~A' ~~~~'v~ , ~f"F and 1 ~
~~y~ (State) ~
n r~
resided at ~~~~A~~`JP~_~.s' K r~ w . However, 1 have changed my domicile to
(Street and NumAet) '
and am and have bcen a bona fide resident of the State of Florid~ since ~ day of '
~r,~ 4. , 19 and I reside at ~A1i'~E ~o ~ Q `~A~.Q~1v f~~~c 102~~~~
(Street and Num~er)
1 E~ k~ ~ F~ u,s ~ County, Florida,
~ - , c~G - ~ , - -
- - •
tc~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of ~lorida.
(lasetl here anr perli~ent iacts, sucA as sale of propertr or business, ot reliaquishment ot ~mplormmt at former
domic7e. removal oi tamily to new domicJe, purcAs.se ot Aome. etc.)
ENTERI*~G CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~ -
If entering children in school,
plea~e list the~r names: ,
l7~ a a k r-~ Z,~~v ~~J .
?
) R r~~F,g l~ • 1_ c~~ ~
A ytJ _ ~ w ~ ~ . :
eFIIEC k. c f:~CO~D . ;
~i.tUC~. ;.~UK:1iYtitWl.
` RO::~ =;,:Tfi~b
CLf Rf: ° . v"Dtf~-T
RfCr; ;e ~~r:.;~.E~.
I - ~ l~ ~ ~ ~'~t~ F:
I
i ' , ~
p . ~ ~3~'7 ~3
~
~ -
. ~
;
,
I FURTHER CENTI~Y that E will register at my local address when the registratier. books reopen, and
comply with all other requirements of a legal resident of this State. .
I FURTHER CERT[FY that 1 have no intention to return to my former domicil~, and I intend to remain in
f"~ " y~ c~ ~ ST. LUCIE , County,
~ Florida, permanently. (c~tr)
~ ,j t i , -
~
. ; f _ _
f~i - - '
~ '~_tt,~~ . , ' s:
: ; - . ~ ~s
Sworn~to andsiibssdbed.before me this day of ~ ~ ~ E:
_ - , , 1~~ iiL- ts
' . , ` A. D. 19.~4~. / ' ~ ~
" ~ ~ :
• `
ROG~ 7RC T.~i1~ ~~t~4,~'~ i•cf~l,~'-~' , Florida
- , _ -c : - - . .
.
.
Ry Deputy Clerk ~ k~~! nr ~
BOOK ~J1 YAt,c ,~,L;~
: ~
, ~ _
~ - ~
; .
,~~,~~r,, ,
v:
~ - - -
s _ . _ _ , _ . _ x ~ ~
~
.