HomeMy WebLinkAbout0796 Decl~r~tion of Domicile and ~itizenship i
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~'O TtiC STATE AND COUNTY '!'AX ASSL:SSOIt,
s•r. ;.uctE MrnuN-rv, F~oK~»n: 29Q14~
'iliis is my dccla~ation of Uamicile and Citi7ensliip in thc Statc of Florida that I am filing this day in
acconiancc, and in conformity ;with Section 222. t 7, Florida Statutcs.
~ ~ L /~i Dl1 ~ and 1
i was formcrly a legal resid~nt of P~~ ~~~r~ • ~~~~Q~
~ ct~~7i~ •s.~u. A~~ . However. 1 have changed my domicite to
residcd at
(Sireet snd Nutr.bet)
and am and have b~.~en a bona fide resident of the State of Florida since day of
~ , 19~ and 1 reside at ' ~
~ ( t sad Numbe~)
~s~~ ,Q~?,~ , . County, Florida, .
~ (citr - s
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in thc St3te
ot' Florida. .
(lase~t here anr pertiQent txts, such as sate of property or business. or relinryuishmcat ot employment at tormer
doaicle. temonsl ui tamilr to new domicile. purchase of home, etc.)
ENTERING CHILDREN IN SCHOOL; ~ HOMESTEAD EXEMPTION: ~
If enCering children in school, _
ple se list their ames: ~
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cow~`
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aec~~ ~~T~~?s ~
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I FURTHER CERTIFY that I wi{l register at my local address when the registrat~on books reopen, and
comply with all other requirements of a legal resident of this State. .
I FURTHER CER"TIFY that 1 have no intention to return to my former domicile, and I intend to remain in
ST. LUCIE County,
Florida, permanendy. cci~r) ~ ~
a: E
_ , _ _ _ :
1~;~. ~ i
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S~ararn to~and sU~sc~I+~d before me this day of "
- ~~a ~ -
'f A.D.19~4 . ~T.Z
' -
- _ - T ~ , Florida
ROGER' cn~T c.
II _ Leputy Clerk
. 60t~li( ~ P~ ~
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. . "'m ~'!;s~.+"'r3 . _..~ifd~ t"~'.!"~..... . . . . _