HomeMy WebLinkAbout0614 Declaration of Domicile and Citiz~nship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpU~y~ FLORIDA:
'It~is is my declaration of Damicila and Citizenship !n thc Statc of Florida that I am filing this day in
accordance, and in conformity with Scction 222.17, Florida Statutes.
I was formerly a legal resident of QET~t ~ Sb~4 ,~g$~ ~ A D and I
tc~ir) (scu:)
resided at ~
ood w 1 S CO NSi N ~v~ ~ . However, 1 have changed my domicile to
(Strest artd NumOsr)
and am and have been a bona fide resident of the State of Florida since ~ sr day of
14 u G-u S T' , 19 73 and I residc at 3~~ Z~E'R 5 e~ eo ~.c~2i
_ , csu~.i .pa tv~~~)
0 2'T' 1' ~ t R c G S t. Luc ie County, Florida,
.
(ct~y) - ~
and this statemeni is t~ i~ taken as my decfaration o€ citizen hes
p, aci~ai e~r
gTres~e=~~~n~rnnicil~-in-the-St$te=
of Florida. ~
(Insu1 Aere snr pertinent facts. suth ss sale oi propettr ot business. or relinquithmeat ot empiorme~t st former
daoic~e, remoral of fsmily to new domicile, purchase of home. ete.)
• HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN SCHOOL.
If entering children in school, ~
please list their names: .
-~('cT //Q~ D r~O Nj Ft D c.Ci4 ScRvt ~ t
- bN i3 J-u~.~ ~9?3,
- P~-t R~ N A~ c~ I~fo C i4 T~ B° vc
~ T-. . . h al
~ T. P~ C~c.C /4 b D ~2~ S S a ~ ~ ~ ~ _ . .
fItEO ANC KECORQE~ •
St. WClE COWtT1t fa
ROCE ~ rOt~RAS t+
CIfRK 4~~~~~tT ~~RT ~
pFr!~q^ Ir''`f E~
, - O~c 3 9 3~ I~'1a
E
~ - ~E14~ _
I FURTHER CERTIFY that [ wiU register at my local address when the registration books-reopen, and
~ comply with all othcr requirements of a legal resident of this State. ~
I FURTHER CERTIFY that 1 have no intention to return td my former domicile, and I intend to remain in
I-' ~~T I~iER ~C ~ ST. LUCIE , County,
Florida, permanendy. tc~~r) ,
~iN ~ s s) `N
~
SIGNATURE
Swor~..~d'~ri~`~u_b~cribed.before me this ~ day of
<<_ f ._ti : A.D. t 9 74 .
-r' ;,~,r=' ,-z- -;4 - ng re s s
,~s ~
- ~ ~tpC~R; . ~~R~AS:~ :_.~LERK CIRCUIT COURT
, Florida
~ •x`i ery.q... : ^s:~ ~ ~~St.'~:t'~ ~
. .fi~~ '
.:~~r~ . ..:.~:Y~~ ~puty Clerk . •
.,.r t, :
; o,.,.. ~
(~o be e ted in du, l~cate and oritioal tiled with Clerk Circuit Court. ~nd duplic te with Taz Asaesso~)
p R
_ 9C~K .PA~~ ~ .
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