HomeMy WebLinkAbout0317 ~
D~ciaration of Domicite and Citiiensh~p
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1 C~ Tlil: STA1'1: ANU CUUNTY 7'AX ASSt:SSQlt, f
s~r, LUCIE iZ~9805
_ _ _ COUNTY, FL~itIUA:
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77iis is my dcclaration of Domicilc and Citizcnship in the State of Florida thal I am tiling thi~ ~ay in
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accordance, and in confarmity with Section 222.17, Florida Statutes.
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1 was formerly a legal resident•of - k~tiSks ~iTv , i'hissnu~~' and 1
(Citr) (Stsee)
r~sided at Ntht~-~-Lc,~.~-~~'~ However, 1 have changed my domicite to ~
(Stteet sad Numper) t~
and am and have been a bona Cde resident of the State of Florida since ~ 7 day of r
19~., and I reside at ~
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~.~~G~,•1 , ~_____~(-!~~.~c. _ - County, Florida,
(a~r)
and this statement is to be t~ken as my deciaration of citizenship, actual legal residPnce and domicile in the State
of Florida. ~
(InsCti Aere sny pertineot fxls, such as sak of propertr or business, or relinquisRment ot employmeat at torma _
damic~7e~ remo.al of fsmily to ~ew domicile, purchax of home. ete.)
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ENTERING CHILDREN IN SCHOOL: HdMESTEAD EXEMPTION: ~
If entering children in school;
please list their names: ~
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I FURTHER CERTIFY that I will register at my local address when the registratiun books reopen, dnd £
c~mply with all other requirements ef a legal resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domicile, ar,d I intend to remain in
ST . LUC IE County,
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Florida, permanently. ~c~~r) ~ ~C~9 PRNE S' ~j~,yN,~~y7
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Sworn•R+4~;attd~~bscribed before me this y day of ~
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, A.D. 19~4~. ~L
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_ ~~R ~ ' _ ~ , Florida
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By, ' Deputy Clerk ~
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