HomeMy WebLinkAbout0537 Declaration of Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE _ CpU~y~ F~ORIDA:
This ia my declaratiar o~~omicile and Citize~ship in thc State of Florida that I am filing this day in
aocordance, and in conformity with Section 222.17, Florida Statutes.
1 wat formerly a legal resident of ~~.~.~a , • and I
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a~ 1¢,~ ~~a ~ru ~_..,~__r. ~ . Howcver, I have dtanged my domicile to
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and am aad have been a bona fide r~sident ort the State of Florida since ~~-5 , day of
.~e~.~. ~ , 19~~., and I reside at Tr ~s,~ ~ ~ 5 ~ ?e~.
~ , (Str~st aed Number) ~
~ 7: ~i e_re u ~ ~ St. Lucie County, Florida, .
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anci tbis staiem+~~t ~s t~ b~ tal?en as my d~~iaration of citizenship, act~al lsgal residence and domi~l~ in th~ State -
of Flarida. .
_.(Ia~at Aere aar pertiaent f~cts. sueA ss s~le oi pwpertr or Ousinaa. ot rNiaquishment ot ~nployment st tormer
doa~le~ ren+oral ot hmilr ~o aew domicile. purchase ot howe, etc.) .
N S HOOL: HOMESTEAD EXEMPTION:_ ~
ENTERING CHILDRE. IN C
If entering children in school, ~
please list their names: _ ~~~57 ,
r~ ~j-,r~,vc. , 5 ~~t~- 1~L FILEO AND AECORQE~
ST. ~UCiE C.OUNTY F~
ROGER FOITRAS
R ,~~__~~_r . CtERK CI~CUIT COURT
t RfCORt` YERIF~EO..,.~...~
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I FiJRTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with ap other requ'uements of a legal resident of this State. ~
I FiJRTHER CERTIFY that t have no intention to re,turn to my former domicile, and I intend to remain in
~...T ~rG ~ ST . LUCIE County,
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Flor~a~,pg~!nanently. c~tr)
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- . ~ _ ~ ~ ~ = ~ IGNATURE
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•~~yq~r'to ~''a~`s~iDs~iibed before rne this ~ day of
" 74 ~
- ('v~g~'"'I.~'Tr,4-~?~,~~s
- A.D. 19
i g re s
SOGER ITRAS CLERK CIRCUIT COURT T- ~.~c~~ FlOridB
g ~ ~'~ti~c-C~ Deputy C1erk _ : .
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(To be ezecuted in d~.~ '~_ate and otiEinal filed with Ckrk Circuil Courl. snd duplic~te with 7~x Asse~s... i
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