HomeMy WebLinkAbout0071 r / ~
. , ~ ~ ~ • • ~
Declarat~on of Domrcile and Citizenship
'PO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpUNTY, FLORIDA:
'Ihis is my declaration oP Domicilc and Citiaenship in the Statc of Ftorida that 1 am filing this day in
acoordance, and in conforroity with Section 222.17, Flonda Statutes.
1 was formerly a tegal resident of and I
- ~ lpey) ~ _ ' ( )
resided at : However, I have changed my domicile to
(Stroti ~ad NumOet) ~
and am and have becn a bona fide resident of, the State of Florida since 8 day of
~ ~ P-D„ P 1~ _
rrL~o-~~ p-~,,.-a~_____ , 19~ and I reside at - ~
~ , tsa«~.ndrt~meer~
~ St . Lucie County, Florida, 4
(canr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida .
(Inaert Aere anr pertinent tscts. such as sale of propertr or businas+ ot relta9uahment ot emplorment st twmer
domicie. temoral offaatilr to aew domicik. PurcAase ot hoane. ete.) ,
ENTERING CHILDREN IN SCHOOI~: . HOMESTEAD EXEMPTION:~
If entering children in school,
please list their names:
-~L+L-~L ~ .
~ .
- flLE6 ~,.n a.._ _ _
. sfi UlCfE ~p(jpN
fu -
ROC~F ?Q17qAS ~
AF. ~OR Rx C13CUtT CDURT _
o vra~~j~a
- _ - . ~r 1S 2 PH'l+~
2%~
4
~ ~
r ~
i ~ .
1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all oiher requirements of a teg,al resident of this State.
1 FURTHER RTIFY that I have no intention to return to my former domicile, and I intend to remain in
' ST. LUCIE County,
,
Florida, permanently. cc'"'~
~ ~ _ r ~ J~,
~ ~:.~~~ns.s? ' : ,
~ ,.•~a~~~ ' ' . - - R
; r,. .
',~~{.`~'i!'.`+s'.i;~~s:~` '',w~?.J,
. s~, ..K~;;...,,; ti,~.~,> = ~
. :
5
y,~=, -~~,`~N~; f IGNA
: . G~ , .
~ .
. • -~~tL' ~ ~ a ~ .
~ b : ~
Sw~ t47 ~dlsub '~;ore me this day of
.
_ ` ' ~r- 74
~ ~ ~ ' ~ ` A. D. I 9 re
ROGg~~ ~S ~ CLERK C RCUIT COURT _
j~ y~ ~ ~ Florida
gy puty Clerk .
~TO b! lkKY in duplka~e and orisinal fikd with Cir:k C'atuit Courf, snd duplic~te with Ts: Aaeasot) ~
6~(hl~~ PAI;i ~ .
q, ~
_ - _ _ -
r~ ` - ~ - - ,
~~h.~`..__..,... ~s. . __a r.~°~±-_~3~-.
W: