HomeMy WebLinkAbout0538 Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpV~y~ FLORIDA: ~6~8
This Is my declaration of Dumicile and Citizenship in the State of Fiortda that I am ftling thls day in
accoTdance, and in conformity wi~h Section 222.17, Florida Statutes. ~
I was iormerly a legal resident of N i L l.'S D q Le. ~ Ne- w Te R s e y and 1
tCttr) tstsa)
resided at N i'~- K e.12 BoC. Ke R ~t ~ e... However, 1 hava changed my domicile to
(Sasse •ad NumbK)
and am and have been a bona fide resident of the State of Florida since F~RS T' day of
I~c c e~n ~ e~ , 19~ , and I reside at 5~ F.e ~~Rq ~~-I w y-# s
ti (Suest tad Numeer)
~1-. p~ ~R c. e.._ St . Lucie County, Florida,
(~er) . .
and this statement is to be [aken as n~y ~c~iarati~n af citizznsltip, actual lega! r~idance ~nd dQnucile in the Si~te
of Florida.
(insert herc aor pertiaeat fscts. sucA as sale ot propertr a~p~. a rellnquishmen~ ot employmeat at tormec
doioio8e, remo~ral ot tamilr eo aew domkile. Purchase ot home. ete.) -
N SCHOOL: HOMESTEAD EXEMPTION: ~
ENTERING CHILDREN I ~ ,
If entering children in school, W--1
please list their names: ~
5 s a. h J.e H r~ F'R o s Ic e `
T(} M~ e. S~e R~ R ~ 1""Ro S 1C~ 'FILED a.y~ RECOROEO . ~
1/ Q _ ST. luCtF C~UNTY FIA, ~
iJ A1 .1.. fl ~ i Il'~ 3 K C,- RMre _ .
CLER. • v,i«~5
~ C~~CUiT COURT
RFC+'4Q YE?r.c;cp~~ ,
. ~ - . ~ 1 12 so PH'1~
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' 368
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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 1 have no intention to return to my former domicile, and I intend to remain in
~T. - F~i e R c- e ST . LUCIE County,
, ~
Florida, permanently. ~~i`r~
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p •:,•3 ~ S IGNATURE
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: Swo 'bed before me this ~ day of
Q;g 74 ~ S, ~eo eRFT t- rv y~#-
.a~~~ ~
f ~ ' A.D. 19
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~ : t'1'~ - CLERK IRCUIT COURT ~T-_ ~ ~R c ~ , Florida
~'ft'.'rrt~~~M'S~t~;,.~=: -
g c~t Deputy Clerk _ , ~
- (To p ecuted in duplicate and ori6inal t~ed with Clcrk Circuit Cout1. ~nd duplicate with Tax As~asor)
. 60CK~ PACf ~ . -
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