HomeMy WebLinkAbout1763 i~
Decl~r~tion of Domicile and Cetizenship '
i~
~i1
~lo~~~ ± a
~f0 TH~ STAT~ ANU C'UUNTY TAX ASS~:SSOlt,
ST. LUCIE _~~pUNTY, FLURIDA: ' -
-
'Il~is is my dcclarutian of Domicilc and Citit.enshi~ in thc Statr of Florida that ! am filing this day in
accordancc, ~nd in conforn~ity with Scction 222.17, Florida Statutes. '
~ ~ o v~ S/.~iYf~- and i
1 was formcrly a Icgal rc~ident of ~ ~ 0 va ,
(Cit (St.te)
r~ sided at ~ e . However, I have changed my domicile to
(Strett snd Numbcr)
a~~d am and have bccn. a bona Cde nsidrnt of thc State of Florida since ~ day of
~ e~ 19~ and 1.csidc at !i v a~ ~ v N N~ R 7f ~/S' ~
• (Sueet and Numbet) ~tz.t
S~, L v~,~ ~ _ L v C l~ County, Florida,
(c~tr)
and this statement is to be taken as my declaration of citizenship, actuai legal resid~nce anJ domicil~ in the State i
of Florida. .
(Inserl here any ~tinent fxts, such u sale of properly or busioess• or ~elinqu'uhmeot of employment at tormer
domicile, temoral ot familY lo new domi.ile, purcAase of home. etcJ
a ~iOMESTEAD EXEMPTION: a `
E.vTERI. G CHILDREN IN SCli00L:
If entering children in school,
please list their names: 2~81$
~ ~0 ~INi ir
~~A taswis
I~E~irE!!ti
~ j 8 5i ~'7
/ . ~4"
' ,~CU~~l:~~/L~ ;-~t~.c•.c-~ . .
j ~ -
f
~
I FURTHER CERTIFY that 1 well register at my local address when the registration books reo~•en, and
comply with all other requirements ef a legai resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to mq former domicile, and I intend to remain in
~ ST. LUCI~ , Caunty,
Florida, permanently. «'~y~
y~;;
.I .}'1; . , .
.J ~
• . ~ -
• . . ~ . -
~
S~aroru to and sub~cnbed bef~re me this ~ day of
~ ~ ^ ~ A.D. 19 74 - . -
CTRC 1C IT CO[IgT- , Florida
ROGER POITRAS, CIERY
gy ~i.~~lu~, Com l~.C~ Deputy Clerk ,
~ ~oaK ~1 1~~i _
~ A~r~ T-, , ^I
~
~ ~ 5~'-~: ~-.T"ac~ ~
?p ~ ~ ~ ~ ~
v~
. . . . p'g h . . . .