HomeMy WebLinkAbout0367 Dec~ara~iot~-~f Domicil~ anci Citiz~nship ~
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I~i) Ttlt: STATE: ANU COUNTY TAX ASSESSOR,
5T. I.UCIE _ COUNTY, FLORlDA:
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71iis is my declaration of Dc~micile and Citizenship in the State oP Flurida that 1 am iiling this day in
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accordance, and in conformiiy with Section 222.17, Florida Statutes. ~ , i}
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i was formerly a legal resident.of G%/mO~Pr , ~/P~L9~l~ and 1 .
tcitr) (stste)
resided at ~ q!~~~9~P ~1~ ~1 . . However, 1 have changed my domicile to
(Street and Numbe~) ~
and am and have becn a bona Gdc resident of the State of Florida since _ day oF
u.v ~ , 19~y and I residc at 7io ~ ~i T~t~S /.C ~ ~d
(Stteet and Number~
f~, F,P(~~ s%• L y c' i t County, Florida,
(c.ti~r)
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and ihis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any paYlinent tacts, such ss sak of property or businas, or relinquithment ot emplormrnt at tormer
domicle. removal of familr to ncw domicile. p::rchase f home, etc.)
ENTERINC CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: a
If enteri~g children in school, ~.9$~z
please list their names: -
iILEC : ~'c„p~DEO ~
n ST. tJC•F ~~t'kTY F~~,
~I' F:i~ , i ii' i RAS
/9/CN~~' '.l~Fi? ~I~~ ~ GLFr,~, ~•Ji7 CGI:Rt
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with alt ether requirements of a lega3 resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ST. LUCIE
f
% . / ~,PC~ E , County,
Florida, permanently. ~
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Sworn to and subseribed before me this _ day of ~
` ~ A. U. 19 74 _ ?
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R~GER POITRAS. CLERK CIRCUIT COIj~ , Florida ,
R/C~~~ l~~l~ De ut lerk
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e~2~31 ~ ~67 ` }
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