HomeMy WebLinkAbout2265 tion of Do~icile and Citizenship
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ATE AND CullNTY `TA3+ ASSL'SSOR, ~
1 O 1 tl[: ST
ST. LUCIE ~ ~~5~ ~
COUNTY, FLORII?A: _ . ' ~ ~
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This is my dcclaration ot Domicilr and Citizcnship in thc State of rlorida that 1 am filing this day in
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accordancc. and in conformity with Scction 222.17, Florida Statutcs.
I was formcrly a lcgal resident of Fo/' t ~ Q u cre d 4 1 P F 1~~~~Q and 1
~ (cit7) (stste)
resided at . However, t have changed my domicile to
(Street and NumOcr)
and am and have lx~cn a bona fide nsidcnt of the State of Ftorida since day of
, 19-L, and 1 reside at 3 1 I`~ -f1
- (St~ee. ~nd NumAs~)
~ o P, ~e r ~ t s t L u c~~ e County, Florida,
.
(ntr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
uf Florida.
(losert here anr pettinent fxts, sucA as ssle of ptopertr or business, o? telinquaAment ot emplorment at to:mer
' domic~e, remo~•al ot familr to aew domicile, purchasc of home, etc.) ~ _
E:VTERI*?G CtiILDREN IN SCI~OOL: ~I. ~~OMESTEAD EXCMPTION:
If entering children in school,
please list their names: ~
G
RECORp
1~~?FpRF~t~~~~ ~~tlRt C
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~~ss
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I FURTHF.R CERTIFY that I wiQ register at my local address when the registration books mo~en, and
comply with all otheF requirements ~f a legal reside~t of this State.
1 FURTHER CERTIFY that 1 fiave no intention t~ return to my former domicile, anci I intend to rrrnain in
ST. LUCIE , County,
Fo~t I`'~ erce -
Florida, permanently.
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S~ilronil to aud~su ~iefore me this / U day of ~ M - -
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- A.D. 19~~. -
_~ti;ti,z-~'x' ' ~ er~ e , Florida
ROGE d'` _
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gy puty Clerk •
. aooK 231 2260 .
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