HomeMy WebLinkAbout2126 Declaration of Domiciie and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, rZ9S~1,
ST. LUCIE CpUNTY, FLORIDA: '
This is my dcclaration of Domicile and Citizenship in thc State of Florida that 1 am filing this day in
accordance, and in conformity with Section 22.17, Florida Statutes. ~
I was formerly a legal resident of G~-~~i/ ~ and I
(aer) ~ ( a)
resided at . However, I have changed my domicile to
' (Strsst snd Number) S.r -
and am and have been a bona fide resident of the State of Florida since day of
~/AN~AR~/ , 19~.y and 1 reside at 3~u rc~,/iso~ ~~v?A~vD /Qr f1~A
( , ~sm.~.pa N~mw~)
~ . St . Lucie 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.
(Inse~t here. snr pertinent tacts. wcA ss sale ot prope~tr or businest. or ~elinquisi~ment ot employment ~t formet
domkilc. removal ot (~mi17r to new domieile, purchase ot home. ete.)
LDREN IN SCHOOL: HOMESTEAD EXEMPTION:
ENTERING CHI ~ _
If entering children in school,
pleage list their names:
~ 295341
F ~EO °~o~.EiNgY .
s~. tuc ~t
R06Ei: POtT11A1 .
II CIE~R L'titCU1T CQURt
I AECOR~~ ~€?~FlEO
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~ t5 12 azPM'Z~ -
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. '
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
f~ ~-crlrr~,~ l~L ND ~ ST. LUCIE , County,
Florid~„p~rmanently. «'t''~
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. , • ~ ~ " . _ ~ ~ - ~ S IGNATURE
`$~qrn-~oa , liscribed bef re me this 1- day of
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, ; /'C
~ , 74 oZ o 0/'~4
A.D. 19
ng r s
ROGER POITRAS, CLERK CIRCUIT COURT ?Eiys~,~r ~E~~r~`, Florida
- ~ 33~~t 7
gy ,~c~c.d~ c~~~puty Clerk . .
(To Ae sxecuted in dupikate and ori~tinsl filed with C1e?k Circuit Courl, and duplicde with Tax Assr.~.~r)
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