HomeMy WebLinkAbout0365 Qeciaration of Dornic~le and Citizenship
"i~0 THI: STATE ANU COLINTY TAX ASSI:SSOR, 2~9850 ~~i
ST. LUCIE _Cp~~NT1', HLORIUA:
"Il~is is my dcclaration of Domicilc and Citiicnship in thc State of Florida tl~at ! am filing this day in
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accordance. and in confarmity with Section 222.17, Florida Statutes. '
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1 was formerly a lcgal residcnt.of ~
. o (Citr) ' (State) }
res~ded at /70 S'~i~~ ~ - . Hawevcr, I havc changcd my domicile to
(St~tet sod NumEer)
and am and have been a bona fide resident of the State of Florida since 3 7~ day of
, 19 and I reside at ~~r~ 8~
~ K~.pa N~~,en)
~f~~'~ County, Florida,
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and this statement is to be taken as my declaration af citizenship, actual legal residence and domicile in the State
of Florida. _
(Insert hete snr ~tiner.t fxts, such u sate ot propettr o~ business. ot reliaquishment ot emplormrnt at [onau
domicae, remoral ot tamilr to new domicile. purci~ax of home, ete.)
ENTERING CHILDREN IN S~HOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names: ~98~0
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FiIE[~ :-Mt_ -eEC~RDE11
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Glf = :.U~' COURT
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I FURTHER CERTIFY that I will register at my local addr~ss when the registration bonks reopen, and
comply with ail other reauirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intentio~ to return to my former domicile, and I intend to remain in
~ ST. LUCIE Count
~ Y,
Florida, permanently. tc~ir~
1 `t` ' i / / ~
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Sworn to and sub~cpbctt before me this day of •
f '
. ' ^~~-~-E~ .4~'-+r~G ' "
- - , A.D. 19~~.
, Florida
ROGER P ITRA~~ CI_F K. R.LTT .O~gT- ~
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By,,~~~ ~*z Deputy Clerk ~
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