HomeMy WebLinkAbout1370 Declaration of Domicile and Citizenship ?~J
TO'THE STATE ANDCOUNTY TAX ASSESSOR,
ST. LUCIE CpU~y~ FLORIDA: ~~5`~8
'Riis is my declaration of Domicile and Citizenship in the State of Ftorida that I am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~~?G , i~~9lZ ?L A.?1~ and I
(Citr) ~ ~
resided at ~ ~~P~?1~i7~G e ST/1~PT . However, I have changed my domicile to
'(Stntt ~nd Numbs~)
and am and have been a bona fide resident of the State of Flarida since ~s ~ day of
OC To ~3 e2 , 19-~, and I reside at 3-~ s-~i?h/A~J ~?P/t v~
. . (StrMt sud Numbet)
FT j~e2c~e st. Lucie county, Florida,
(cur)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
~~ns~n n.~e snr r~*cine~~ tsces. su~n a~e ot proPerir or bus~~. or reunqu~nmen~ ot em~ormene u tonner
domieiie. ~emo~rsl ot taa~ilr ~o aew domkae. Purd~sse oi home. etc.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION:
If entering children in school,
please list their names:
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i REC4R0 YERIFIEfl
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident- of this State.
I FURTHER CERTIFY that [ have no intention to return to my former domicile, and I intend to remain in
~-7 e ST. LUCIE County,
,
Florida, permanently. tci~r~ .
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~ "SGv;dr~i:t~nd s~,~ed before me this day of
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~ C d A.D. 19 74 e3/~?-~ 1~-~-
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~ ROGER POITRAS CLERK C RCUIT COURT , Florida
gy , G ~ ,v Deputy Clerk
(To ~:~cuted ia duplkate ~nd ai~inal fded wilh Clerk Ctrcuk CoYrt. ~ad duplkate with Tu Aoe~wr)
--y ~ ~ - S ~1370~ ; ~
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