HomeMy WebLinkAbout0554 laration of Domicile and Citizenship ~
Dec
TO THE STATE AND COUNTY'TAX ASSESSOR, ~~19
ST.' LUCIE CpV~y, FLORlDA:
'11iis is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes. ~
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1 was fotmerly a legal resident of ~ ~~y~
r- `~a " /.Z ~ . However, I have ~changed my domicile to
resided at • ~~j ~r ~
..r~.. ' (Strit NumOet)
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and am and have been a bona fide resident of the State of Florida since daY of
_ , 19~,~., and I reside at ~ "•o Nw.e.r)
esa«e
.
s~ _ St. Lucie County, Fiorida,
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(cstr) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(la~rt he~e anr pertinewt t~cts. such as sale ot p~opertY a b~~ a rNinquisAment ot emploru~ent st twe~a
domicile. cemoval ot tsenilr to new domicile. P~+chss~ of Aoae. ete.)
n
ENTERING CHILDREN IN SCHOOL: ~ HQMESTEAD EXEMPTION:
If entering children in school,
please list their names:
~~~u~ t~~~,~ i
~fti P~~~~ ;
CLERK CrRCUlT ~p~ ~ t
RECORD yER~F~EO~~~~ :
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with ail 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
" ~ ST. LUCIE County,
(I : ~ . N~'~ ~ . ~
Florida, permanently,;:_ (cnr) •
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~ ~ . ~ j' • ! r ~~fore me this day of
Swo ~id~ ,
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,t......,•• 74 /.2 / ~ ti
A.D. 19 ~~n~-~11~._~ : ~ ~z
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ROGER POITRAS CIERK IRCUIT COURT ~ Florida
z~''%CE,!_-r s
g Deputy Clerk
Y
(To b~ t M dupliuts ~nd ori~inai fiied with ps~k Circuit Coutt. ~ad duplicats with Ts~ Awawr)
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