HomeMy WebLinkAbout1068 Declaration of Domicile and Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR, .
ST. LUCIE CpUNTY, FLORIUA:
This is my declaration of Domicile and Citizenship in thc State of Florida that I am fding this day in
accardance, and in conformity with Section 222.17, Florida Statutcs.
. : •
1 was formerly a Icgal resident of ~ ~ 1J ~ S~~\~ ~ and I
(Citr) ' (Stste) .
resided at ~ • L . However, I have changed my domicile to
. (Street snd Number) I S'~.
and- ~t~ and have becn a bona Cde residcnt af the. State of Florida since day of
, 19~ and I reside at ~ , h
t snd Numbcr)
~ ~ St . Lucie Couniy, Florida,
.
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and this ~statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State
Flori~s.
~ (Inseri here any pe~tinent tacts. such as ssk ot property or Dustness. or relfnquishment of emplorment st to~mv
domicde, removsl ot familr to new domicile. purchsse of home. ete.)
S HOOL: HOMESTEAD EXEMPTIO?~: ~
ErITERING CNILDREN IN C .
If entering children in school,
please list ~heir names: .
_ e ~ n ~1 . K -
h__._ .
ST
LUCfE ~0~~~~~
' ROCE : POiT S
CLERK C:~CUIT SUAT
. - 4E~?~~ ~~~F•~FIEO
' ' ~ -9 I~ y8 ~'T~
~
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~s~s~
~ ~ ~ - ~
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1 FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
~ comply with all other requirements of a lega! resident of this State. ~ -
I FURTHER CERTIFY that 1 have no intention to return to my farnier domicile, and I intend to remain in
; ST. LUCIE , County,
Florida, permanently. «'`r)
~
,
~ `
~ _ ` ~ _ ~ S IGNATURE
.,~y~; , . i .
.`r j .
Swo ~t`~b~ ~~~~~.:bcfore me this day of
G,~I A.D. 19 74
~ ~z.-: • ng r ss
• y Sa..-
$ ~ • ~ ITR,A~= a (i~RK CIRCUIT COURT - , Florida ~
_ f ..•i~(+ ~ : ; r,,; -
~7,~ ~ + Z`_ 'Y` . t,~l S : ~
=~y~ ~Y~~. .:i-' ~i ~ ~ ~
gy>-, ~ • Deputy Clerk _ . .
ii,,~, ~
s~~ ~ ~ t}jbe e cutal in duplicale snd otqtinal tiled with Cktk Circuit Court. and duplic~te wilA Tsx Assesfo~)
n~;~i i .
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