HomeMy WebLinkAbout0587 / ~
~eciaration of Dor~icile and Citizenship . :
. !
I(~ 'CHE STATG ANU CVUNTY TAX ASSESSOR. • i fi
-2'`~23 ~ ~
~
ST. LUCIE CpUNTY, F~LORIDA: ~
. ~
71~is is my decla~ation of Domicile and Citizenship in the State of Florida that 1 am filing this day in
. ;
~ ~
;~ccordance, and in conformity with Section 222.17, Florida Statutes.
~ ~ ` and I
1 was formerty a legal resident.of ~
(ci~r) /
rrsided at ' . wever, I have cha ~ed my domicile to !
uK~ .~d , r~meK~
and am and have been a bona fiJe resident of -the State of Florida since day of .
~ 19 and 1 reside at ~
' (Street an umbet)
~ < < . ` County, Flarida,
( 'ir) i
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Fiorida.
(lnsert Aere aar perti~ent fscts, such as sale ot propetty o~ Dusinas. ot teiiaQuithmrnt ot employmeat at to~mer
domicie. nmoral ot familr to aew domieile. Purchase ot home. etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION:
If entering children in school, ~ ,
please list their names:
- 1 ,i
i :
- ~
. - •
rr~ea ~NU ~ECORU~o ~
=T. LUCIE COUNTY ELA.
- - ROCER ~OITRAS b
CIERK CtRCUIT COIMT
P.ECORD YER:FIEO
; Ara t3 3 ~ PM'Z~1 ~
~
~ ~f~~3
~
~ .
~ , - ~
- ~
~
I FURTHER CERTIFY that I wiU register at my local address when the registration books teopen, and
eomply with all other requirements of a legal resicient of this State. ~
I FURTHER CERTIFY that ! have no intention to return to my former domicile, and I intend to remain in
~ - ST. LUCIE
~ , County,
Florida, permanentiy.
-
`
.
L:;;.- . ~ -
, ~ h e ~ h u N~
~ j~ . f~''~ . ` ~ ~ "
Swiorn to and~subscnbed be~`ore me tl~is ~ day o
. . . ~ :z _ ~ s
~ ` ' A.D. 19_~4_. ~ ~
- ` i1RT , Florida f
ROGLR ' •
. . , _ ; i.
~3y Deputy Clerk ~ ~
y:.
$~DK ~ ~Jli'# a~~, .
. ~
Ar.t, r
_ _ - - - - -
- _ ,
- - - -
~_r~,.~, 3,
~
. _ ;.'~_.~y~_: . _