HomeMy WebLinkAbout2129 Deciar~tion of Do~nicite and C~tizenship
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7'tJ Tt1E STATC AND COUNTY TAX ASSESSOR, ~~a'71 t~
ST. LUCIE CpV~'y, ~LORIDA: ~1
This is my dcclaratinn of Domicilc and Citizcnsfiip in thc Stai~ of Florida lhat 1 am filing ihis day in
accocdancc, and in conformity with Scction 222.17, Florida Statutcs. ,
1 was formcriy a legal residcnt of n" ,~1f
~e ~ s and i ~
(Ci~r) (s~aee)
~ T f
jj~ . However, 1 have changed my domicile to
r~sidcd at ' ~ a '
~ N~~~~ 9~ aa,? of
and am• and have been a bona Gdc residcnt of the State of Florida sin~x
~fif. !!F~ , 19 f
~ , and I reside at ~-3~ ~ `r° ~l ~ ~ ~ r- c
~ ~f • (5veet awd Hu~Oa)
~erC ~ ~ c~./ County, Florida,
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(nir)
and this statement is to be taken as my declaration of citizenship, actual legat residence and domicile in the State
vf Florida.
(laser/ hae say Pe*tiaent fscts. wch as sale of propKtr or baio~. p K~9°isAmewt ot ew~ployvewt st fo~wer :
dwnici'e. remo~ral ot tamilr to aow domicile. Purc~e ot Aaae. etc.) - z
• HOMESTEAD EXEMPTION: ~
ENTERI":G CNILDREN IN SCNOOL. ,
If entering children in school,
please list their name~;
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I FURTHER CERTIFY that 1 will re~t
~dent of th ~Stat
a~ When the registration books reopen, and
comply with all other requuements of a lega
1 FURTHER CERTIFY tb:. have no intention to return to my former domicile, and I intend to remain in
/ /f ~':r L _ ST . LUCIE , County,
rmanend caa~
Florida, pe Y-
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~~'"''~'~4`' ~c r , r'lorida
R r_nttRT
gy Deputy Clerk -
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