HomeMy WebLinkAbout0262 laration of Domicile and Citizenship_
Dec ,
TO THE S'I'ATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpV~Y, FLORIDA: 293961
This is my declars~tion of Domecilc and Citizenship in the State of Florida that I am tlGng this day in
~ .
accbTrdance, and in conformity wi~h Section 22?.1?, Florida Statutes.
. 1 was formerly a iegal resident of NtcN~~?iJ and I
. (cny) ' t~~~
~ZI MRP~E 13t~a . However, I have changed my domicile to
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d~ at ~sa~.~.~+a K~meK) -
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and am and have been a bona . fide resident of the State of Florida since . Z~ . day of
SePTet~r3~.-~ , 19.~., and I reside at 3'Zq 1J E A'~'"~LEY ~v~
- , - ~ ~S~fN~ ~Od NYAOOf~
'Po~I Sr 1.vc~ e ~ - _ St . Lucie . County, Florida,
(ci~r) .
a~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State -
of Florida. ~ ~ .
(Insett here anr pertinent bcts,;uef? as sale of ptopettr ot Dusinas. or teliaquishment ot employment at tormer
• danie~. removsl ot fuailr to aew danicde. purcbsse o( Aoa~e, etc.)
~ . HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN SCHOOL. ~ .
If entering children in school,
please list their names: .
THoHAS A ~•~~~uAt~~--~
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_ ~ iT.l~
E LG~
~ CtERI~ C~RCUtt COWtr
~ ~ ~ RECdRD YERIFIED
~ Oc~ 23 3 PH'T~
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. 293961
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 I have no intention to retum to my former domicile, and I intend to remain in
~o~T ST Lv ~ E 5T. LUCIE County,
,
Florida, pcrmanently. ,
~ . ~G. C~/.~~e
~ 5I~'NATOKF:
~ - - SIGNATURE
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Sworn fo:~sisi~eiiti~ribed~.before me this~ day of _
: , . 74
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~-si' : ,~::~~'a~~~=:~;- _ A.D. 19
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R~:~ P~3I~RA`$ ~,ERK CIRCUIT COURT , Florida
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g `S Deputy Clerk .r . •
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~~~di «nted ia duplieste snd ori`in~) filed witb Citrk Circ~~il Coutt. ~nd duplicate wlth Tax assessot)
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