HomeMy WebLinkAbout2003 ~ , i
Dec~~ration of Darnicile an+d Citiz~nship~~
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7'G T11E STATt: ANU COUtiTY TAX AS5L• SSOR.
ST. LUCIE i~9~9~2 ~
_ COUNTY, FLORIUA: „ i
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'Ihis is my drelaration ot Domicilc and Citizcnshi~~ in thc State of Ftorida th~t I am filing this day in ~i
accordancc, and in conformity with Scction 222.17, Florida Statutcs. - '
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1 was forn~crly a icgal resident of ~ • ~ ~
(~-r~ (State)
rcsidcd at ~ ~A~ C . Howevcr, I havc changed my domicile to
- lsue.t sna N6mecr)
and am and have bccn a bona fide nsidcnt of the State c~f FlQrida since ~ day of
~ .
191~, and I resid~ at ~~5~~ N~m~)
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S . , ~,~,p ~ ~ County, Florida,
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' (citr)
and this statement is to be taken as my declaration of citizenship, actual lega! residence and domici;~ in the State
of Florida.
(lnsert here any pe~tinent facts. sucA as sale ot property o~ busieess, o~ relinquisAmeat of emploYmeut at former .
domic~e. remoral ot tamily to new domicile. Purchase of home. etc.)
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E'.VTERI"?G CHILDREN IN SCHOOL: C~. HOMESTEAD EXCMPTION:
If entering children in school,
please list their names: .
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1~CQ'LL ~/lA~'Y ,~~.C~1~1 - ~ `S
~ I~KER`R~~I~~RRS ~
Ot.~ CiilOtllT O~T ~
f ~~lGOAO YEft~T1f0~....,.~.,.
I ~ ~ 111? ~M'l~i
_ 29~9`72
I FURTNER CEQTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements ef a legal resident of this State.
1 FURTHER CERTIFY that i have no intention to return to my former domicile, and 1 intend to remain in
~ ST. LUCIE , County,
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~ Florida, permanentiy.
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Svq~}~ ~.to~~d subsc~ ~fefore me this day of y~
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. 19 74 _
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sR' a~~ %'CE~ ~ ~ ~ FlOrld8
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gy Deputy Clerk U oK~J~
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