HomeMy WebLinkAbout2061 D~claration of DomiCil~ and Citizenship ' ; i~
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~ro Tt11: STATC ANU COUNTY TAX ASSLSSOR.
ST. LUCIE _ CpUNI'Y, FLORIDA:
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Tl~is is my dcclaration af Domicilc and C;ti~cnsliip in thc State ot Florida that I am fi~ing this day in
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accordance, :~nd in conformity with ~~~~o~ 222• ~ F~orida Statutcs.
1 was formcrly a Ic~l residen~of ~~n''L'~~ - - and I
(Citr) (SUts)
residcd ~t ~ l However, 1 have changed my domicile to
(5trat aad NumDe~)
d8~1 Of
and am and have been a bona Gde nsidenl of the State of Flarid~nce
_ , ~ 9__, and 1 reside at ~ ~~Street aad Number) •
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d ~ 1 County, Florida,
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~ (Cilr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Fiorida.
(Inserl here anr {?e~~ineat facts, such u sak of propertr or bus~ness. or K~~nquishment of emFlorment at tormer _
• dan~ule~ ~ernarsl ot familr to aew domicile, purchax ot home, etc.)
~HOMESTEAD EXEMPTIUN: ~ '
E'VTERI*?G CHILDREN IN SCHOOL: ~ ~
If entering children in school, ~~~21#
please Iist their names:
s~i~,°c
F °u'w~.,~
~ ° ~ ~ ~ CIERK`C RCWT~QfIRT
NEC0110 VfRIF1E0~
S~t 9 ~t 0~ PN'~~I
;
I FURTHER CERT[FY that 1 will register at my local address when the registration books reopen, and
comply with all other requirements Qf a legal resident of this State.
I FURTHEit CERTIFY that 1 have no intention to return to my former domicite, and I intend to remain in -
ST . LUCIE , County,
Fio~da;:pe~an~ntly. ~~i"'~
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- ' ~ rL, - '
` - ; o ~ 7 ~ day of -
Sworri to ~fig su~scribcd before me this
fv . - p.D. 19 74 _ . .
" , Florida
ROGER POITRAS CIEFY rTU~ttT~r CallRT-
gy ~i,G ~oy~-~ Deputy Clerk •
• ~i.~i Ai,-~~lh7U
A(:(l fr~rr: 'i-'.:
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