HomeMy WebLinkAbout1395 tion c~f Do~nicile and Citizenship
Declara s..
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TO Tt1E STATE AND CUUNTY TAX ASSI:SSOIt, ,
ST. LUCIE CpUN`1'Y, FLORID~1: +
71~is is my drelaration af Domici~c and Citi7cns)iip ir~ thc State of Florida that t am filing this day in
accordancc, and in conformity with Section 222.17, Florida Statutes.
~ ° ' C~+~ ~~~~nd 1
1 was formerly a Irgal res'sdent ~f _~~.-S~~" ~
r~ ' (s~.~.~
~Q~, ~ ~ , However, 1 have changed my domicile to
iCS1dC(~ dl --L ~pd Number)
~ d8~/ Of
and am and have becn a bona fide nsident of the State of Florida sin~ ~
0
~ 9~, and I reside at a
_ , (St t sad Number)
_ County, Florida,
~_A~L_r ~ ~
(CitlrT
and this statement is to be taken as my declaration of citizenship, actual legal tesidence and domicile in the State
of Florida. _
(Intetl hete aor pe~~~nrnt fxts, sucA u sale oi propettr or business, or reG~9~~°~~nt ot emplorm~nt at tormer
domic~. remoral of [amily to aew domicile, purcAzse af home. ete•)
~ .
E1~TERI*?G CHII.DREP~ IN SCHOOL: a HOMESTEAD EXEMPTION: ~
If entering children in school, ~
please list their names: . _
1~~rJ.-w~ Q '~r.J,,13~
~i-ii~etcM~3~j~~R~
Ctfn~4`'~ ~~:'RfS
rF ~ ~c~~t~irCQURt
-GOicr~ ~:?~1=~: fl~`~~~~(.L(,(~ ~ ~ •
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1 FURTHER CERTIFY that 1 wili register at my local address when the registration books reopen, and
comply with all other requirements ef a legal resident of this State. ,
I FURTtiER CERTIFY that [ havz no intention to return to my former domicile, and I intend to remain in
d ST. LUCIE , County,
~j~,_~--L.~
Florida, permanently. (~'`r~
(~~9 L'~!y h ~ ~ ~a
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~
..s~~iiiil/(~~- ~ ` . ~ f) -
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~,_G-~;~.~~ii,~~.:; /i/ 1 ~
3 ~ da of / ~ .
Sworti~ ei~!'~cifi~B~fQre me this Y SO `
. . .3" r _ . , s , .
- ~y, Y , ~ : Q ~ .
_ '
= • • - ' ' A.D. 19 74 -
_ , Florida
R ~ ~ -
f * -
. ~i ' • .
~ By ~ - ` ~ ~ Puty Clerk -
~ ~°0~~31 ~1394
- ~ Acn r~,.~.. , . - -
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