HomeMy WebLinkAbout0192 r tion of Domicile and Citizenship ~
Decia a
TO THE STATE AND COUNTY TAX ASSESSOR~ ~~~,$SO
ST. LUCIE ~p~~y~ FLORIDA:
This is my declaration of Domicile and Citizenship ~n the State of Florida that l am Riing this day in
acco~dance, and in canformity with Section 222.17, Florida Statutes.
1 was formerly a legai resident of ~51~1 :o~- , c~- and I
' (st.a)
(dir) •
resided at Z~~ ~ y d*' - . However, I have changed my domicile to .
(sa«e .aa Hrme.~)
and am and have been a bana fide resident of the State of Florida since ~ ~ day of
, 191~._, and I reside at '-~.3 ~ / .S~-~ ~u~va~v
_ , (sa.se.ss Nome.~)
~ p~E~~ y _ S t. Luc ie County, Florida,
(a~r)
and this statement is to be taken as my declaration of citizenship, actual legai residence and domicile in the State
of Florida. ~
(lraat Aere aaf Dsniaeot tacts. wcA as sak ot Pwp~tY ar businas. a rcliaq~i~hment ot aaplores~at st to~~r
• domic~e. ree~ora~ of hmilr to aaw daniciN. Purduse ot Aome, ete.)
• HOMEST'£AD EXEMPTION: ~
ENTERING CHILDREN IN SCHOOL.
If entering children in schoolt
please list their names:
bi n fl . . ~ '~it~ i,C,`n
l-~' ~ _
p AND 1tECORp~~ ~
ST.l1iC1E COWIri ~lA.
Rp~EP PO1TRAa
CIERR Ca~F~EO ~WRr
RECORO ~E
~ ~ ~y 1 ~z PM'T~I
i -
~
~
~
~ - 29~850 -
~ .
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I FURTHER CERTIFY that I wiU register at my local address when the registration bouks reopen, and
~ comply with all oth~r requirements of a legal•resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
~ ~ ,~~u . ST . LUC IE County,
,
Florida, permanently. ~~i"'~ '
~
_ . . .~d
~
~hz
0~7
~ U; ~ S I8~1A1'URE
~ . -
~ . .•4'~iSi: '%,'?s •C~'~•~ .
, ' • ~ 0.-
~ Swern to `8nd'~ibset~~d.before me this ~ day of
~i -t ~ ~:r~%~~ -i'a _ n
_ - -•a~~ _ A.D. 19 74 ~ 1 W ~
~ , .-x; . :
1~ •B: ~ = ~ CIERK CIRCUIT COURT , Florida
, . 0:'s'
~ ~ ~
"t''"~~ Deputy Clerk
~ By • .
(To b~ ~ ~NO ie drplicate and otE~ina1 t~sd with (]e~k Circuit Court. a~d duPlicat~ witb 7~c Aw~) - w
~ ~ ~ . d00K~~~3~+ YAGE
x,
AGQ Form 7 i' Z `
_ , , . - - - - - - ~ G"`'~~~ ,~,v'L-'`~ ~
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