HomeMy WebLinkAbout0585 . • y~
D~ctarat~on of Dorn~c~le ar~d C~tizenship .
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'fO '1'lit: STATE ANi) CC~UNTY TAX ASSI:SSOR, -
S T. LUC I C ~~~~zl r
_ COUNTY, FLORIllA:
This is my dcclaration of Domicilc and Citizensltip in ti~c Statc of Florida that 1 am ~ling this day in
:~cconlance, and in conformity with Sectian 222.17, Florida Statutes. ~ '
. . •
i was formerl a legat resident.of ~~/~~PS ~n~ • and I
,
y (City) (3tate) i
~ ~~P,~S/!~' E~Y~° . However, 1 have changed my domicile to `
resided at _ i
(Sireet snd Numaet) ~ ~
and am and have been a bona fide resident of the State of Florida since 3- _day af ~
1 ' o C, ~7 /,iF.~~e ~/r ¢
/7Gt%~~.7 , 19~~C, and 1 reside at
~ (Stree~a~d NumOer)
~ zo ,e~' ~ , v~~ ~L~ ~ / e- County, Florida,
(~~r)
a>>d this statement is to be taken as my decl~ration of citizenship, actual legal residence and domicile in the State
of Florida. -
(I~aert AaYe any pertinent fxts, suth at ssle of p~opertr or business, or retinquish~neat of employmeat at totmet
domic~le. temo~ral of tamily to new domicile, psuchsse of home. ete.)
ENTERING CHILDREN IN SCHOOL: ~I. HOMESTEAD EXEMPTION: a
If entering children in school, ~~,~,i,q~~E ~tS~~~A~t,
please list their names: • ~
, ~O~ER IOIt Af , _
~1 Ol~Rlt CIRC IT QOURT ; _
s[JC ~~~1~ •~c~/I~'I ~ ~l ~ R[t~R~ vta~ri~p~ -
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1 FURTHER CERZ`IFY that I will register at my local addre~ when tlie registrafion books reopen, and ~
comply with all other requirements of a legal resident of this State.
i
I FURTHER CEltT1FY that ! have no intention to return to my former domi~ile, and I inte;~d to remain in
~ P ~ ST. LUCIE , County, ~
~ ~ / Z°
Florida, permanently. t~~+r)
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Sv~i~n~to and s.u~seribe~ietore me this day of '
- 4
; - - ~ ' ..r~G ~ ~-7'~ /~~~.E~~'~° L!~
A.D.19_74 -
' j:~1'•=:;. : Y,:-.~:
• /~j ~,P~ei , Florida
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