HomeMy WebLinkAbout1103 ~ ' ' itizensh' ~
Declaration of Dom~cile and C ~p ~
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TO TNE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpUNTY, FLORlDA:
This is my declaration of Domicile and Citizenship in the State of Flor~da that I am R1Ing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
I was formerly a legal resident of ~v D r~h~~ ~d I
(p~r) . (S~.a)
resided at ~o a~ ~ . However, I havo changed my domicile Lo
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and am and have been a bona fide sesident of the State of Florida since day of
d~.~nr
b~Y` , 19_~., and I reside at ~..~8 ! s~~ ~~~11 J 0.--
+ ~ (SttMt aad NnmMt)
S`r' L, ~ ~ ~:e _ St . Luc ie County, Florida,
(citr) _
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Inssrt Aere any pettinsnt tacts, such as s:le ot pwpatr a pusinas. or rclinquid~a~eat of ~apiormeat at iormet .
domicile. reraoval ot tsmilr to new domicile, purchase ot hom~. etc.) ~
~ _ • HOMESTEAD~ EXEYIPTION:
ENTERING rHILDREN IN SCHOOL. ~ .
If entering children in school, --t-
please list their r~ames:
~94595~ .
~-i ~ W-V1----- Q- E~ ~ f LED ANO R~C R ~
_ _ - S~ IUCIE COU~jr ~
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T? V~ 0. ~ e e ~1~'~ ~A 1 C'Y, REC tERk C~~;CUIt COURt
01tQ VEF.eF~E~~s
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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 FURTHER CERTIFY that I have no intention to ~turn to my former domicile, and I intend to remain in
~ ~ ~ ~ ST . LUCIE _ , County,
~o S -
Florida, permanently. ccnr~
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~ : K~ • = S IGNATiIRE
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Si~v~ji: to ana:s~ibs~nbed before me this day of
~Y~ ~',~G`~-~-~ A.D. 19 74
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ROGER POITRAS, CLERK CIRCUIT COURT , Florida
g ~~Z~G'~~~ Deputy Clerk _ ,
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(To be eseeute0 in duplicate ~nJ ~ri~inal filed with Clrrk C~cuit Cour1. snd dupiic~te with Tu Asfeaor)
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