HomeMy WebLinkAbout0364 Dectaration of Domicite and Citizenship ~
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1~Q 1'ti4 STA'l~l: ANU COUNTY 'f.tX ASSl:SSOlt, ~
_ ST. LUCIE_ _ LpUN7'Y, FLORIUA:
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Tiiis is my dccla~ation af Domicilc and CitiTCnship i~i the Statc of Florida ihat I am fiting this day in
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accor~fance, and in conformity with Sertion 222.17, Florida Statutrs. .
1 was fornlerly a teg~l rcsident•of.. - ~ _ , and 1
(~~r) (Succ)
resided at 3~~ ~~Q•~J . However, I have changed my domicile to
. (St~eet and Nu be~) ~ ~
and am and have been a bona fide resident of thc State of Ftorida since ~ j day of t
_ , 19_-, and 1 rNSide at ~~G/ • o,~'`' ~
(Sttcet sad Numb )
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(Gtr)
and this statement is to be taken as my declaration of citizenship, ctual legal residence and domicile in the State
of Florida.
(liaeri hcre any pertinent fscts, such ai sale ot propertr or business, ~~nliaquishment of employme~t st former
domic~le. temoral ut fa~nilr to aew domicJe, piuchase of home. ete.)
ENTERING CHILDREN IN SCHOOL: II. HOMESTEAD EXEMPTION: ~
If e~tering children in school, ,
please list their name •
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~9849 -
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i SL lU~~~C COUNTY FlA.
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1 FURTHER CERTIFY that I will register at my local address when the registration boaks reopen, and
comply with all other requirements of a lega! residerit of this State. .
I FURTHE ERTIFY that I have no intentior. to return to my former domicile, and I intend to remain in
. ' ST . LUC IE County,
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Florida, permanently. «'t''~
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5wotr~ to and subscnbed before me this 2- , day of
' A.D. 19~ ~ a
ROC:ER POITRA_~__C]-FRK CIR
.SUIT_CO 1RT , Florida -
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B Deputy Clerk ~
g~~K 23i P~~ 364 .
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