HomeMy WebLinkAbout1069 Declaration of Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE ~pU~y~ FLORtDA:
'll~~ is my declaration of Domicile and Citizenship in the Statc of Florida that I am t31ing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
I was formerly a legal resident of ___~[~s~e~~~ , and I
(cin)
~ .
resided at 3~
l~'.t~~~.~_.-f="' . However, 1 have changed my domicile to
(stnst and Numeer)
arrd am and have becn a bona fide resident of the State of Florida since day of
~~~(~it- , 19~~., and I reside at ,~~r~
• _ . csa~set .oa Nume.r)
St . Lucie County, Florida,
~ ~ _ .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. _ - ~
(lascrt pere ~nr pertinent tacts. such as sale ot propertr or business. or celiaqu~SRmmt ot smploymeat st former
domlcHe. remorsl of tunilr to ~1ew domicile, Purehsse ot home. ete.) ~ ,
~ • HOMESTEAD EXEMPTION: ~ -
ENTERING CHILDREN IN SCHOOL. ~ _
If entering children in school, , .
please list their names: .
- ~ .
~ fuEO ~NO aECOa~ Q~
i7. AO E:4
PQ NRAS
~ RFCORC YEFIf ED COURT _
~ - ~ Npy ~ 11 .
! '
; 294561 .
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1 FURTHER CERTIFY that I will register at my local-address when the registration books reopen, and
compiy with all other requirements of a legal resident of this State. ~
I Fii THER CERTIFY that I have no intention to return to my form~r domicile, and I intend to remain in
~ a ~ ST. LUCIE , County,
Florida, pe anently. (c~~r) .
~
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` ; S IGNATURE
~y:,. v . ~ . r. . . •
T ~J~-- :tF . r ~j:.. .
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Swo~~~p and §ub~i~4~b~I~; ~e this day of .
' ~ t1~,...'. -.r t f. . . _ ~ 'r~,:=t" 74
t, ; 5+~ T ;~r° p.D. 19 . Q /•2
~ • - . ,~ai~• r
~
RO~~ ~~IERK CIRCUIT COURT ~ , Florida
_ ~
a ' ~ 3 ~s ~
gy Deputy Clerk
` (To be uted in dup~~cue and ori6inal ti~ed with Cktk Circuit Coutt, snd duplieate with Tss A~sessor)
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