HomeMy WebLinkAbout1104 D~cl~;ratia~ o~ Dor~~~~~~ ~r~~
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O 7~1 it: STA'1'1: ANU COUN'l~Y TAX ASSLSSOIt,
ST. LUCI~ ~~UNTY, 1=LORIUA:
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11iis is my dcclaration of Uornicilc and Citi•r.~i~ship in thc: Stat~ of l~lorida that 1 am tilin~; this day in
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<<cror~lanc~, anJ in .:onfoniiity with Scctio~i 232.17, rlorida Statutcs.
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1 w.~s formcrly a le~;al residciit af .~~'~~z--~1~ and 1
~ . (Ci~Y) ~ (state)
?~sidrd at ~yJ_-~L~9~K~ - - • tiowcvcr, 1 have chanbcd my domicila ta
( ett a~J Number
and am and h.ivr tx:en a bona fide residcnt of tlte St1te of F~torida since _ day ot'
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, - ! 9 ~ and ! rrsidc at --~'a~N-~~~. ~ . ~~~c.cr ~OIC%~
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St. I.tlcie _ County, Florida,
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.~nd this statcmcnt is to bc takcn as my dcclaration of citi~cnship, actual Irgal residcnce and domicilc in the Statc i
uf Finrida_ _ [
(Inseri he~c any pertinr~t facls, such ac sale af pmpe~ly or busines, or relinyuishmeni ot employment at (ormer
damicilr, rc~novai of tamily lo new dumicilt, purchasc of homc, ctc.)
* ~IG CHILDREPZ IT~i SCHO~L: HOMESTEAD EXEMPTTO~I: ~
F.~ITERI ~ . .
If et~tering children in school,
please list their n~mes: _
r1 ~EO ~MC? RE~oRp~o ~ -
" - ST.LUCIE C~UMT1' FLA. e
ROCE~ ~i; RAS
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REC~lR~ yE::~FiE~~
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1 FURTHER CERTIf
Y th~it I wiU registcr at my local address when the rcgistration books rcopcn, and -
comply ~vitli all other requircments of a legal resi~ient of this State.
1 FURTIiER CERTIFY that 1 ha~e no intenteon to return to m~~ former domicile, and I intend to remain in
ST. LUC~~ County,
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Sr~,~~~.~` ~tit~,~cribcd beforr mr this da~~ of
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P.(~GER POITRAS, CLis'RK CIRCL~T COU1tT , Florida
~ `~~-c-~c~ Deputy Clerk .
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To t*r e~ecuteJ in du .ti: rlo auJ ~~ri~;in:+l fded wilh (9rrk Citcui! C~.ucl, anJ Jupliente wilh Tax Assessur) ~
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