HomeMy WebLinkAbout0513 . . ~f~
Declaration of Dar~icile and C~tizenship
'PO TNE S'TATE AND COUNTY TAX ASSESSOR, . ~~~9
ST. LUCIE CptJNTY, FLORIDA: .
'Iliis is my dc;claration of Domicilc and Citizenship in the Statc of Florida that I am filing this day in
accordance, and In oonformity with Scction 222.17, Florida~tatutes.
1 was formcrly a legal resident of . w , and I
o~ (Cih) (Sqa)
resided at -~~~h~ _ . How~ever, I have changed my domicile to
~ ~ csu..~.aa H~me.~) ~ /
and am and have been a bona fide resident of~ the State of Florida since ~~!~___!~er~ ~ day of
, 19,~ and I reside at ~ .
• ~ ( • a.a Nwoe.r) ;
St . Lucie County, Florida,
. (cier) ~ - - .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
_ (lat~t hae any pettineat taets. such as sale ot pmperty or M~sinat. or relioQuhAment ot emploYmeat at to~sar
• doe~icile. remoral ot ismilr to new domicile. purc6w o[ Aoms. ete.) - ~
ENTERING CHILDREN IN SCHOOL: ~j HOMESTEAD EXEMPTION:
If •entering c.hildren in school, L~---1 ~
please list their names: " ~
~iE.~uc~E cou~TY f~~. ~
ROCER POfTRAS -
CLERK ClRCUIt COUIIt
RECORB YER~FIEO ;
- . Oei 2~ II ~o ~!!'t~l
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~ 294159 _
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1 FURTHER CERTIFY that I will register at my iocal 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
A~~~~,,Ge ~ ST. LUCIE , County,
Florida, permanently. .
~ - G~~ •
~ ' ~ ~
y ~ . S IGNATURE -
, , -
SworR'~;~i~'~abscAb~d before me this day of ,
. ~ ~
. ~
:
h'~'~ ~~;f _.-0~~~{` A.D. 19 74 a~~i~~
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;~.:ER CIRCUIT COURT , Flarida
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-~e~ ~i. 1•~. '~.w~•1~. . ~
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B~. ' Deputy Clerk w. - .
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(To be ~ e ~led in duplic~te ~nd oti~insl f7ed with Ck~k Circuit Couri. ~nd duplkate witl~ Tuc Aau~sat)
: eo~x 23~ P~cE 51~ -
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