HomeMy WebLinkAbout0822 • ' ' itizer~shi ~ ~ ~
Deciarat~on of Dom~c~te and C p
;
.
. Zm
1~C~ T~IfE STATE AND C'OUNTY TAX ASSESSOR, 2~~-sz a~~
_ ST. LUCIE ___CpUNTY, FLORIDA: ~ ~ b.'~
This is my drelaration of Dami~ile and Citizensl~ip in the State of Florida that ~ am filing this day in :
. ~
.
accordance, and in conformity with Scction 222.17, Florida Statutes.
~,-,-p a v7~"e- ~/1a~~A na and I k
1 was formcrly a lcgal residc~it of ~s~,«~
t~~r) .
r~ sid~d at s -~v~"h ~~f~ s+re~t , Howaver, t have changed my domicile to ~
r (Street and Numbec)
and am and h:.vc t~cen a bona fide resicicnt of th~ State of Florida since day of
o Scufyi 3.3 QD S- f :
, 19 7
y- and 1 reside at . t
- (Street ami Number)
• , St. Lucie County,Florida, 7~~
P~ e nc P_
cc~~y~ ~ ~
and tliis statement is to be taken as my declarati~n of citizenship, actual legal residence and domicile in the State
of Florida. ~ ~ ~ ~
(~nsett hert sny pertinent fscts, sucA as sate of ptupertg o~ business, oc reliaquishment ot emplormmt st tormer !
domic~7e. removal ot famii7 to new domicile. pwchase of homs, ete.) !
. H~MES'TEAU EXEMPTIC~N: ~
ENTERING CHILDREN IN SCHOOL. ~ - ~
If entering children in school,
please list their names: !
~
#~m ~ / - /~/L,i ~ ~ n _P!'nni~./
0 AMD RE NteE~ ~ , ;
~WC1E COt1 fu, }
- AOCf R Pp~ AS V ~
- aLEUR C~aCUIT 0~~ ' . i
RF~ORO VER!ifEp
~ , a~ u. ~o ~r~
,
~ .
E
~ . -
~ ~
~
1 FURTHER C~RTIFY that I wiil register at my lacal 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 ~ntention to return to m~ former domicile, and I intend to remain in
~rC~ ST. LUCI~ County,
~ '
Florida, permanenily. ~~'`r)
.l' _ I
,,~~~~~Nr~(~~j•~~:
•~y
; G~~i'~- ~ ^ ,
~
•
`',;t-. . S IGNATURE
_ : ~ .
:%~.t.
. : ~ ; ~
: : , _ r e ;
~}~~~o ~,•siibsc~~ .before me this day of _ ,
f..~,~,. . ~ - ~ p.D. 19 74 `.Sj7~ SS, ~.3~'c~ ~
: -
~ . f ~ 0,~ n8
R~~p~.g S CLERK IRCUIT COURT P C~~__, Florida
_ -
gy Deputy Clerk
~"'[o be t ~ted in duplicate and ~insl filed vrith C1etk Cirtuit Court, ~ad duplicate with Tax Assessot?
~ 8Q~ ~ PA~ ~ - _ .
n~~ ? . _
_ n ~ w~~ - - (~`ij -
_ ~