HomeMy WebLinkAbout0540 Deciaration of Domicile and Citizenship ,
TO THE STATE AND COUNTY TAX ASSESSOR, ~ !~~3~0
ST. LUCIE CpUNTY, FLORtDA:
This is my dcclaration of Domicile and Citizcnship in the State of Florida that I am tlling thts day in
accordance, and in conformity with Section 222.17, Florida Statutcs.
1 was formerly a legal ~esident of , - e- aad 1
a~ csua)
resided at . However, I have changed my domicile to
tsa..S.aa Ndmea>
and am and have been a bona fide resident of the ~ Statc of Florida since 7~ day of
~ , 19~y and I reside at -
f .na H~~ea)
~ St. Lucie County, Florida,
. (Ci~r) ~
and this statement is to be taken as my declaration oi citizenship, actuai legal residence and domicite i~t the St~t~
of Florida. -
(le~se~t hers an~ pertiaeat t~cts. sucb as sak ot ptopertr o~ Maiiness. or reli~Wuidimeat of anploymeat at tora~e~
domic~e, removal ot familr to aew domkile. purchase ot home. ete.)
ENTERING CNILDREN IN SCHOOL: HOMESTEAD EXEMPTION:
If entering children in school, ~ .
please list their names: ~ ~s~?~r~
fILEO AAtp qE~p~~EO -
:t ~.~crF cou~rr Fu.
RQCEP, r^pt~AS
' CIFRK Ci~CUIT CODRT
RFCQRE+ YER!FIEO-
_ _ - ~ 1 2 04 P!~ ~T
. _
.
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I FURTHER CERTIFY that I wilt 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 return to my former domicile, and I intend to remain in
_ ~ ~ - ~ST. LUCIE
, County,
FIAn~~:Pd~q~~hently. ciiy)
, .
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~ ~ ~ - ` = SIGNATURE
, 7'J
• ',k = ~
~aj `~a-~;~;a~i§cn`lied beforc me this ~ day of A
~..l. 11
~ . - 74 ~o ~ Jl ~ lx.u-c..
~~.,t-t,:~~~c~ l~.e,~,J A.D. 19 0/C o
"Pt~iTff"g Aa'd'
ROGER POITRAS, CLERK CIRCUIT COURT Florida
~ - _
gy~.
~~~~,~.c~G~~'-~-`~-~~ Deputy Clerk
M •
(To be e:ecutcd in dupticate snd ori~insl filed wilh Ckrk Circuit Court. and duplicate with Tu Asreuc~)
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= ~ a s?,e`s x ~ r = _ . _ ' ~-i~„~,. ~ ~"a~~
. ~e. ~ ~~f '~v~~ ~ . _ ~r.~~~~ y~ . .