HomeMy WebLinkAbout2865 De~ctaration ~f Dor~~cile and Citizenship
TO THE STATE AND CQUNTY TAX ASSESSOR,
ST. L[1CIE ~~~92
C~pUNTY, FLORIDA:
'It?is is my dcclaration o[ Domicile and Citiunship ia the State of Flo~ida thst t un feling thi~ day in
accordance. and i~ oonfornuty with Soction 222.17~ Fbrida Statuta. _
! was fomnerly a kgal raidcnt of ~'~=l t~s~ ~ ~r.,~.~d1 aad I
c~~
resided at c~~ ~~-'~-'~ti-c~:.~,_~...• i'~ Ho~ver, I ha~re dung~ed my domicile to
~e.~ ~.a N..
and am and have b~en a bona fide resident of d~e State of flocida sinoe ~ day of
:
, 19_,G'
T- and 1 raide at ~~'--~f'~•~
y~l St . I~ucie County, Ftorida,
te~er) -
and this statement is to be taken as my declu~ation ~f utizens6iP. actw~ 1e~1 ~enoe and danicile in the State
of Florida. -
(lR~en Ywe a.r o~ tacts. s~Y s sale o~ ~rorsts a. ~s:.e~. at to...r
of fa~ff to ~ev~ do~icie.l~'ase o( ~o~e. et~)
. Ii~£S1EAD EXEMPTION: ~
ENTERING CHILDREN IN SCHOOL.
If entering children in school,
please list th ir names:
.
; - ; ~
- s~_~inr.~ co~
~F ~om~s
a.~uc uxcnir~ ~
~ RECOA~ 1fEL:F;E~
S~t ~1 ~i l~'7~
~~92
I FURTHER CERTIFY that 1 will register at my loca! address when ffie registration books reopea, and
comp~y with aU other requirements of a kgal resident of this State_
1 FURTHER RTIFY that i have no intention to return to my fo~mer domicile, and I intend to remain in
~ S"r. IITCIE , Countr,
Florida, permanently. cr•e,~ -
~
. . -
/
. •C'7" . S -
S~i
~oii~ tb aad~bb~ci~be`d before c~e this day of
c A.D. l9 74 ~ J ~/~C.~.~C~
:1~~ ~
' r~=' -
. • ~ ~~R , p(~ ~ CIE CIRCUI? COURT . , Florida
~ / ~~I?.: ~
' $3l- ' ,C , j~plltj/ CIeIk -
(7o M~~coa/ iw d~iu~e a~/ arpd He/ vi~ti Qert Cieit Co~rl. a~/ i~/~icare wit~ T~ Aseaor)
_ .
. a~~~~EZ~ ' AC'r1 F~m ~I~IZ