HomeMy WebLinkAbout1249 Declaration of Domicile and Citizenship ~
.
TO THE STATE AND COUN'TY TAX ASSESSOR, 2SO2
ST. LUCIE ~p~~y~ FLORIDA: -
This is my declaration of Domicile and Citiunship in the State of Florida that t am filing this day in
accordance, and in conformity vin'~h Section 222.17, Florida Statutes.
I was formerly a legal resident of O G O N 0 M 0 W o C ~ lw ~ S~ o~v S i N ~d I
tC?tr) (S~aa)
r~sided at ~ 7~A v? t w Z o~+ . How~ver, i have changed my domic'sle to
(Stnet s~d Numb~t) „~f"
and am and have been a bona fide residcnt of the State of Florida since ~ day of '
N o v E Ih n E R 19~, and I reside at ~ y' 7~7 5_ t. C7 R A P E L/? ~
(sawt a~ [~Iwwbw)
~O R'T S T, ~ V C ~ E ~ St . Lucie County, Florida,
ca~r~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(las~rt Aue aar Vertinsat tacts. sucA as sde ot propertr or bwinaa. ar rNia9ui~hma~t ot ~mplorme~t st to~~r
domiciit, mnoval of fuailr to naw domieilt. Pwc~ ot Aane. etc.)
• ~ HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN SCHOOL. ~ ,
If entering children~in school,
please list their names:
FIIEG AMD RE~R~Ep ~a
- iL AI~ICCER PORRAa LA.
' CtERK CIRCUlT COUJ~T ~ ~
RECORD VERIFIEO
, ~ ~ Z sa Py'l~l
• 2~2502
~ -
E
! -
~ -
~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
compiy 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
~o ~i'x:~:~~~~'• ~ c. ~ E ST. LUCIE , County,
> -..s . (ciri) -
.
Fio-~~~ ,
,.~'-'~`V'1T -f ~ ~ ~ . ~
~ y ~p(-v., _
. G •
ul•i,~'•~ ~,r ~
.
. ~ ~y,~ . ~ . "
b i , . ~Ib'NA
: ` ~ _
m: $ ~
~ ~~s'' : : ~-~r: .
~ j: /
s: t
~ : ~ , ~ ~ . S IGNATURE ~ -
~ .a - _ = _ -
, , ~ ~ O
,1
. ~
. ~
before me this day of .
~ ~
` A.D.19 74 ~i}-~1_ 5_E, C7R/~PELANJ vc
~ ROGER POITRAS CIERK CIRCUI? COURT ~j
pj2 ~ S-c. ~c ~ , Florida
33~-~a
~ ~y ~ Deputy Clerk
(To b~ ~cat~d in OuPlicste u~d ori~in~l tiled with Ckrt Circuit Cowt. ~ad duplic~t~ with T~x Awa~o~)
- = ~ . Bo~~32.:~~~2~49 _ - .
AFn Fe~n 7i 12
- - ~';~~-z~.°~"~'"~ _
:
~
.
~
~ ~ ~
.,~s _m__ ~ ._...~~-~,~.~~~-~.w'~~~ . ~ _~ti~