HomeMy WebLinkAbout0703 /
Declaration of Domicile ~nd Citize~ship
TO THE STATE ANU CUUNl'Y TAX ASSCSSOR, 29QQ9'~
ST. LUCIE CpUNTY, FLORIUA:
'lbis is my dccl:eration ot Domicilc and Citizcnsliip in thc State of Florida that 1 am filing this day in~
:
accordance, and in conformity
with Scction 222.17, Florida Statutes. .
~ ~___.rS~ , ~ ~ and I
1 was form~erly_ a legal resident of ~t1.1 '
t (~ty) (State)
residcd at ~-s`~ S` S~ ~ . Hawever, I have _ ehangcd my domicilc tu
~ (Strtei aad Number)
and am and hav~ been a bona fide resident of the State of Florida sincc Z day of
, 19,~~ t/, and I residc at l~'~ /S` _ ~
(se~«~ .~a N~meK)
~4~" p~~L , County, Florida,
(c~tr) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lesert Aere aor perlinent tacts, such as sak ot propettr or businas, ot telinquishment ot employu~tat st toraer
domic~e. ~cmoral of tsmilr to new domicde, purMue oi home, ete.)
ENTERING CHILDREN IN SCHOOL: ~i. ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names;
~,r.~ '
~
i~~~
c~E cou~ri Fu° ~ ~
ROGER POITtUi ~
CLERR CIRCUIT COilllt
IIECORD VERIf1E0 ;
~ ~ 29 ~'l~
-
2~O~Q9'7
~
I FURTHER CFRTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no i~tention ~a return to my former domicile, and I intend to remain in
ST. Lt7CIE County,
,
Florida, permanently. (~'`r)
~_:~~~i~~±r.. : \ / ~
,~~~a~~lfJijs~_~ J}4,'S:_ V
?.~-f, ~ ~ Zv~
~ l ~f=
ab~~:~.. i,: - ' s ,
~ •i tl=¢!~~~•• :v ~
~ . .
~-`sYi,~: • G"• `t•a
~ :r:~ ~ rNC~
' ~1.~;`--•`~G:it~ ,i' -
s ~ • -
:-r' }
~-•.ti. " p -
. ~ , ` : ~ -,•J~ - -
' ~ .
~ 'ir: . f:3: i.'r_-.'.
~~i~r~o and~ bed,t~efore m~ this day of -
~ . . . ~ .
t ! •
::~.K. ~ = A.D. 19 74 -
~ :.,.;,i+~`~l''` ~ .
~Y , Florida
RoGER~ P ~7T .DUR
By , ~C puty Clerk t
, - ~ 703
- . _
- _ -
. , ~ _
~
- _ _ _ .W ,