HomeMy WebLinkAbout2828 Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, t
ST. LUCIE CpU~y~ F~ORIDA: _
Thts is my declaration of Domicile and Citiaenship in the State of Ftorida that I am tlUng thts day in
acoordance, and in conformity with Section~222.17, Florida Statutes.
1 was formedy a lcgal resident of Ft . Pierce Florida and I
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resided at ~ X~XX~~~~X~~• 1800 Zephyr Ave_.__ However, I have changed my domicile to
tS1rMt a~d Numba)
and am and have becn a bona Rde resident of the State of Florida sincx 2 7 th ~y of
March ,}g_ 54_, and i reside at a03 N. llth Street _
(StrMt aad NtiwbK)
Ft . Pierce St. Lucie County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(la~ert Aae aay pKtineat hcts. sucA as saN ot PruVs*tr or Dusinas. or +sWWai~Ama~t ot a~pbymeat st tormet
domicie. cemovsl ot tamilr to aew dankiM. purd~a+~ ot Aome, etc.)
' OOL: H01~Il:STEAD EXEMPTION: ~
ENTERING CHILDREN IN SCH ~ _
If entering children in school,
please list their names:
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i ~29363'7
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I FURTHER CERTIFY that I wip 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
~
ST. I.UCIE - . . _ s=._
Ft Pi erc~ ~Coiinty,:' ~ ~ _
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Florida, permanently. cc~r~ ' j} ~a~- ~ `'K
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Sworn to and subscribed before me this day of
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A.D.19 74 - 4 ~ L~
ROGER POITRAS, CIERK CIRCUIT COURT Ft. Pierce , Florida
_ gy Deputy Clerk 33450 ~
~TO IN ~=~CYI~ Iw OIIpIICalt aNli Ot~11tI ~!A MIIIA CJltk C~ftY~ COYfI. aad duplicatt with Tai A~ar) •
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