HomeMy WebLinkAbout1361 ~ i ,
neclar~tion of DQrnicile and Citizenship
7~0 TI lE STATI: ANI) COUN"TY 'I'AX ASSI:SSOR,
~~40
ST. LUCIE _~UNTY, ~LnRIDA:
Tl~is is my drela~ation of Uomicilr and Cit~~~.nship in thc Statc of Fiorida that 1 am filing this day in ~
,?cccrJanc~, and in conforniity with Sect' 222.1?. F'da Statutcs. ~
1 was Cormerly a Iegai resident of , - and l
(~ytr) (Sute)
residcd at ~ G,~~ ~S . However, 1 h~vc changed my domicile to
(Street snd Numbe~)
and am aud have b~.~cn a bona fide nsidrnt of the State of Florida since a day of
~ , 19L?~ and 1 msidc at u~~ ~~~~~~C'~~~
(Stte`t aod Number)
~ 0~' . ST ~,.~%~l~ County, Florida,
(Ci~r)
and ihis statement is to be tahen as my declaration of citizenship, actual legal residence and domicile in the State
of rlorida.
(lasetf hrrr any pcrtinrnt facts, sucA as sale of pru{+ettr or business, or telinquishment of employrtient st formr~
domicile, rrmo~al uf family to neN dumicile, pu~chase af Aome, rte_)
F.'1TERI"'G CHILDRE"1 I:V SCNOOL: i~OMESTEAD EYE~IPTION: ~ ~
~
If entering children in school, '
please list their names: :
E~i~
Uit~~ /G~~~ ~'v7l
~v S U 7 E~'/E-L-~
7 ~
~s
s~
i~iF~DCaiM~irRfi~ f L
RO~CER'pITR4t ~
CLERR CIRCUIT COURt t
RfCOR~ YERIf1Ep
~ ~ ~ ~ ~ 4~~ -
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I FURTHER CERTIFY that I witl register at my local address when the registration books reopen, and
comply with all other requirements ~f a legal resident of this State.
I UR? R CERTIFY that t have no intention to return to mq former domicile, and I intend to remain in
• / S . LUCIE County,
,
Florida, permanently.
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4viro~_t3 and s~ s~1.',t`~b,ea before me this ~ay of _
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A. D. I 9~ ~
ROGEI~r''pdx.• ~UST C~U$Z._ , Florida ;
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