HomeMy WebLinkAbout2693 Declaration of Domicile and Citizenship
'PO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpUNTY, FLORIDA: ~3~~~
This is my declaration of Domicilc and Cltizenship in the State of Florida that I am Rling this day In
accotdance, and in conformity with Sectio~ 222.17, Florida St~tutes.
.1 was formerly a legal resident of -~a and I
(da) ~a~
resided at .~1 . However, I have changed my domicile to
tsv..:..a N~me..)
and am and have been a bona 6de resident of the State of Florida sincx 1~'~S " 7`~ day of
, 19_..._, and I reside at ~~o~ ~ N~ F,JE ~~'e~! ~ gdv ~~.v d _
~ (sa..~ ~.a N~~e.r)
~?~Q, ~Q~ St . Luc ie County, Fiorida,
(CUr) ~ .
and this statement is to be taken as my declaration of citizenship, actual legal raidence and domicile in the State
of Florida.
(int~t het~ w1 PKtiaeat hcts, such as ~ale of property or businat. or ~slin9uid?meat ot emplo]rmeat st to~a~~
dwsieW. remoral ot family to new domlciN, purcAa~e of home. etc.)
N SCHOOL: HOMESTEAD EXEMPTION: ~
ENTERING CHILDREN I . .
If entering children in school, K~~
please list their names;
~~~C°o•r/~r/~~L ~ _ - _
e~., AN,v /'1~'~°.,,~,~E~~ .
- s~°ure~eo~~rr~r~. ~
- ~oc~~ ~at~?s L~
_ ae++~ c~~c~ co~t ~
~~caRa vEa~F,~o.._..w....
p~t 16 ll s~ IIM'~~1
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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 FURTNER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~.T ~ . ST. LUCIE - County,
,E~e~ , ,
Florida, permanently.
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,~GU1i : cLC. ~C ~ e N m ~o r'1~e
~ ` ' S IGNATURE
~p .i..b,~ ~ ~'•,~'X .
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:
G ~
~ s~y ~~et G _
~yr ~ !~l~c~d~efore me this day of
+A~2~.'~ ~ ,.'f l'6:r~'. . y :L
_N.~ .~•~~?.s: 7~?
: ' - A.D. 19
;
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~?CIE CIRCUIT COURT - , Florida
, . -
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=~CO~.~~,~
gy ~ " Deputy Clerk ~
(To be s uted in duplicste ~nd ori~ina{ filed with Clstk Ctrcuit Court, ~nd duplicaN wilh Tue As~eaw~)
enoK232 PacE~~~ ~ A,
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