HomeMy WebLinkAbout0109 • ' ' nd Citiienship ~ ~
Deciaration of Dom~cile a
TO THE STATE AND COUNTY TAX ASSESSOR, 2~~~
ST. LUCIE CpV~y, FLORIDA:
'I1~is is my declaration of Domicile and Citizenship in the State of Flotida that 1 am fiUng this daY in
accordance, artd in conformity with Section 222. i 7, Ftorida Statutes.
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1 was formerly a legal reside~t of ~a~~ cs~
~QOs ~'jn~R ~ c~f ivu . However, I havo cha~?8ed my domicile to
resided at ~
~su«e ~a HYme.~) day of
and am and have been a bona Rde resident of the State of Florida sincx
` , 19~~. and 1 r~side at q6'iE ~ //D~~~ .~4~~ % l1 fi
(gtt~1 ~wd Nuw~bK)
St. Lucie County, Florida,
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and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile in the State
of Florida.
a~, a n~qu~Ro~nc ot emplor~sest at ro~
(tas~tt hen anr Pe*tinent tacts. such ss sak ot pwpertf Iam~, ete.)
. doiuiei~, remorsl ot ruailr to aew domkW, p~
HOMESTEAD- E~MPTION: ~
ENTERING CHILDREN IN SCHOOL: t
If entering children in school,
please list their nemes: ~
N~e.,s ; ~ , ~ N~.~
Q
-
aoc~R ~a~us
CLERt C~BCUit COiMT
RECOA9 YER1f1E0
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I FURTHER CERTIFY that I wilt re8ister at my local address when the re~stration books reopen, and
~ comply with all other requirements of a legal•resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ S.T. LUCIE , County,
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cc~tr)
Florida, permanently.
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. .~,;;r ~4~=. - j,;' SIGNATURE
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_ ~ ' ' .t~.: , .•~ribed before me this -L~- day of
$ ~ • 74 lJ 6/~ ~ ~ v~
N A.D. l9
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R ER POITRAS CIERK CIRCUIT COURT •/~fRC Florida
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B Deputy Clerk •
Y
- (To M~s~e~t~0 in duplieste ~a0 otKinal filsd with Qerk Circuit Court. ud duplkst~ with T~c Awa~or) .
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~ BOOK
• AGO ~'nrr T! 22
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