HomeMy WebLinkAbout0376 .
Qe~laratian of Domicile and Citizensh~p
7 U THE STA'1'L' ANU COUNTY TAX ASSt:SSOR,
ST. LUCIE _~:pUNTY, FLORIUA: ~859 ~
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This is my drelaration of Domicilc and Citi-r.cnship in the St~t~ of Florida that 1 am filing this day in
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acc~rdancc, and in canformity with Section 222.17, Florida Statutcs. •
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1 was tormcrly a tcgal resident of o~ e , f-~r Kc and I
n ~ (~~r) (Stste) 1'
r~sidcd at ~ ~ Nowever, i have changed my domicefe to
(Sueet a~d Numbet)
and am and have bcen a bona Cde resedcni of the State of Florida since day of
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, 19~ and 1 reside at f y~% ~ ~
o (Stteet and Numbet) -
~D ~ ~ i~e ~c ~ ' << < ~ ~ County, Florida, ~
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(Citr) '
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and this statement is to be taken as my declaration of citizeiiship, actual iegal residence and domicile in the State ~
of Florida. ~
(Insert Aete any pertinent facts. such u sale oi propertr or business, o~ relinquishment ot emplorment st formet ~
domic~lt. removal of familr to ~ew domicile, purchase of home. ete.) ~
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~NTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: ~
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If entering children in school,
please list their names:
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ft~Et : 5~: '•E ~e~DfB (~U`` .
~t. LU, ~c )~Y f!L V'
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j FURTHER CERTIFY that 1 wiU register at my local address when the registration books reopen, and ~
eomply with all other requirements of a legal resident of this State.
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I FUR"I~HER CER~'IFY that I have no intention to return to my former domicile, and I intend to remain in
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~ _ ~ ST. LUCIE , County,
Fiarida, pernyanently. [c~~r)
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~ Swo~r~ to~ari~ sub~c~i ,~Ecf.o~re me this day of ' ,
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' • ' ~ - ~ A. D. 19.~_. ~7~~~
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ROGE ~ IR~UIT .oUR ~~.1%~ -l'-~ , Florida ~
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By`~~ Deputy Clerk - ' ~
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