HomeMy WebLinkAbout0381 D~claration of Domicite and Cltizenship
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"Tc~ T711: STATt: ANU COUNTY TAX ASSI:SSOR, ~898b3
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S'r. LUCIG _LOUNTY, ~LORIUA:
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Tliis is my dcclaration of Domicilc and Citizci~ship in tlic State af Florida that 1 am filing this day in t
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accordancc, a~id in confonnity with Scction 222.17, Florida Statutes. ~
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1 was fornierly a tegal resident•of ' , T~?~• an~ 1 ~
(Ci~r) (saee)
reside.i at ~`34~~ ~~~1^ . However, I have changed my domicile to
(Stteet stHd Number)
and am and have bcen a bona fide resident of the State of Florida since day of
, 19~_~__, and 1 reside at 3~3~ ~~~~°-r=Q"
~ (Stteet sad Num~)
_ .~u~ i P~ County, Florida,
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(ca~r)
and this statement is to be taken as my declaration of citizenship, actual tegal residence and domicile in the State
of Florida.
(Irtsert here anr pertinenl fxts. such u sale ot ptoperty or Eusiness, or relinquishment ot employment at fo~mer
Qomicle. remoral of fsmilr to new domicile, purchsse of home, etc.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names: - ~
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~T~~, ~ :rol~ n so n '
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I FURTHER CERTIFY that I wili register at my local address when the registration books reopen, and ~
~omply with ail other requirements of a legal resident of this State. . i
I FURTI-iER CERTIFY that 1 have no intention to return to my former domicile, and I intend t~ remain in ~
~'D~., f ~ ~G , ~ ST. LUCIE , County, ~
Florida, permanently. ~~'t'~
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SworntC~and sut~~n/b@d~~ef~re me this ~~day of ~
~ _ / :j' A.D.19~~. ~3
R~~ ~ ~x-'~' ~ CIRSU T .OtIB - , . ~Florida
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By ~ Deputy Clerk '
800i~ ~e~~ PACE ~S~ `
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