HomeMy WebLinkAbout0569 deciaration of Domicile and Cit~zenship
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'TO Tt1E ST•1TE ANU COUNTY TJ1X ASSL:S: UR, ~
_ ST. LUCIE CpUNTY, FLORIDA:
'iliis is my drela~ation ot Domicile and Citi7cnship in thc Statc of Florida that 1 am filing this day in
accurdaiicc, and ia conforniity with Scction 222.17, Florida Statutes. ~ .
• ` ,p\~ , mo . and I
I was formerly a legal resident of s~~«~
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resided at ~ S 1 a ~v ~ M~.. `J . Howcvcr, 1 have changed my domicilc to
(Stteet and Num~e~)
and am and have bcen a bona fide resident of the State of Florida since , 's day uf
J vtiQ 19 7~, and I reside .~t ~ "'e-
• (Stteet ~ad NumEer)
,~e r~ Q ' S~ ~ c~~ County, Florida,
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(a~r) ;
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicilp in the State
of Florida.
(Insert hae snr perlinent tscts, such as sale of propertr or eusiness. or reliequisAment of employment at tormer
domicile, remorsl of familr to new domicile. purchase oi home, elc.)
ENTERING CHILDREN IN SCNOOL: ~ HOMESTEAD ~XEMPTION: ~
If entering children in school, - ~
please list their nam~s:
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r ~r- ~ c~\~ ~ to ~ .S r - . ~
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FIiE4 k*`: Ft~~~~f0 `
57.LUL'iE ~L'ulitY f~A. 1
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~ CtEf:f. _ ' ~ i C~URT
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o Auc Z3 2 ZS PM'~~1
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal re~~dent of this State. _ -
I FURTHER CERTIEY that I have no intention to ret~arn to my former domicile, and I intend to remain in
P~~~,~ a _ ST. LUCIE , County,
Fiorida, permanently. t~~~r~
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Sworri to'ai~d subseti~b~t'ore me this day of
;
~ ` A.D. 19 74 ~
ROGER''~r,`... T ~OURT - , Florida
By ~ ~ Deputy Cierl~ ~ R x
BOOK PAL1 ~s~Q ;
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