HomeMy WebLinkAbout2065 ration of Domicile and C~t~zenship
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Decla
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1'(i TtiF STATE AND COUNTY TAX ASSESSOR, ~~~Q2~
ST. LUCIE CpUNTY, FL.ORIUA: _
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This is my dcclaration of Domicile and Citizenship in the State of Florida that I am Gling this day in i~
:~ccordance, and in co~formity with Section 222.17, Florida Statutes. t
• >u.~..~ ri.~~ c:<. ti' ~ ~ • "7~ and 1 3
I was formcrly a lcgal n.~sident of ~~=y~
~ 1 ,~j 2, S~ . However, 1 have changed my domicile to
residcd at
lSt~eet aad Number)
and am and have been a bona fidc resident of the State of Florida since S - • day of
- ~ ~~o S E~ a.... ~1~.... -e.. ~ ~ ~..w. c~.~-~.
_ , 19. y- and I reside at ~~~r~
Q . , ~ County, Ftorida,
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(C~Ty~
and this statement is to be taken as my declaration of ciiizenship, actual tega~ residerece and domicile in tt~e State
of Florida. ~
(lasetl Aere anr pe~tinent fxts, such as ssle ot propertr or ~usiness. or K~'rt4uisAi^cnt ot empioyment at fo~mer
danic'~ie. remuval ot tamily to new domicile. Purchase ot home. ets.)
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* IN SCHOOL: ~ HOMESTE~D EXEMPTION: ~
ENTERI.IG CHILDREN
If entering children in school,
please list their names:
C ~L ~c~, ~j,-~~ ~~~---_o~..~ -
~~IE C ~E ~ '
I~~CER POtTRAS
CLERI~ CtRCUI? COURT
IIECORO YERiF1E0
S~r 9 ~1 ss PN'~~i
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I FURTHER CERTlFY that I f a le rel res dent of this Sta ea~ When the registration books reopen, and
comply with all other requirements e ga
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
ST. LUCIE , County,
Florida, permanently. (~'`r~ ~
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. ` d,s,before me this day
. Slacom-.~#ro and su~isc~,, - E- ~~w -,z
<.t., --?i:;~'? A.U. 19~~ - ~ j
~ _ ' _~3 , Florida
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