HomeMy WebLinkAbout1611 Q~cla~atiQn ~f a~m~~ii~ a~d Cstiz~nsn~~
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~i~o ~~ii~ s•rn~~i: nnu cour.~r~' TAX ASSl:SSOR,
S1'. 1.UCIE - - ('UUN"1'Y, f LOR11)A: ~
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'Cl~i. is my cl~rlarati~~i~ uf Vamicilc an~l Citizcnsi~ip in ti~c Si:~i:: of 1=lorida ihat 1 am filing this day in
accorclanc~..uut in conl'ormity with Scction 2'2.17, I~lorida Statutcs.
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1 was formcrly a Icbal rrsidcnt of ~:~~~/OP and I ~
T ,cc~~r) (s~~~r~
msidcd at ~~~~!nCQc~ ____../_~'%l~L Howcvcr, I havc changcd my domicilc to
(Slrcrl and Numbcr)
;uid am and h.i~•c b~cn a bona Gdc nsidcnt of thc Statc of Florida sincc ~ day o1~
--1~ > 19_~„~, and 1 residc at _ .if -
~ / (Str~et and Number)
------~i/ ---~'~~°~P-- - . St. Lucie _ County, Florida,
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and this statcmci~t is to l~c t.~kcn ~is my dcclaration of citixcnship, aciuai icgai r~,ju~ncc and domicilc in thc Statc
c~f Florida. -
(Inser: herc on> prrfinr~l f:+cts, wch as ~:~Ir of ~~r~~p.•rty or busincu, or relinyulthment of en?pluyment at former
domicilc, rcmaval uf family Io nc~~• Ju~~iirilr. purchasc of h~.mc, clc.)
E"I'r1:RI`:G C~,ILDRE*: IN SCI~OOL: I~O2~S'f~AD ~XE1~fPTIO':: ~
If ente-ring clizldren in sc~~ool, ~
plelse list ~?~~ir nanes: ~
- ~99~6
FILED A#0 t!f •9~ . 3
LU~,IE GLt~l~i~
RO~~F F'~i~R~~ .
Gt c'Rx ;,::;C'!IT CO~ytf
RECfi~~ V~a'F~_~a~r
r~ i~ ~~PH ~r5
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4 1 rURTHEIt CI:RTII=Y that 1 will rcrister at m~~ local address whcn thc rcgistration hooks rco~~~n, and
~ cotn~ily with all other rrquirements of a lr,~al residrnt o( this Statr.
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~ I FI~RTHl:R CERTIPY that I ha~•c no intention to return to my former domicilr, and 1 intend to rcmain in
~ ~J S's. LUCIE
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- - - , Cotinfl-,
~ I~lorid~,,~tt~ane~~tly. <<~"'~~
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x y'» ~ . = " K. P. Kubitzky .
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~ ~ . ~ ' : - - S IGI3A1'URE
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Swotti ~0',a(1id~~t~iycril,c~l I~: fc~rr mc tl?is 1~--- clay of
~ ~ciirc.c'`'c - A.D. I ~ _ ~G~~ S ~l~~
~ _ _ _ 1 .lnf; ress
RC~ . ~,R P07TitAS ('1'•:~;K CT}:~l'.T'C CC~i?iZT
~ - ~ ~f /P~_, rloric.u ;
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~ By ~.-c.lc.~ ~n~~ut}~ ~'_E~rk
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(Tu lro c~ci ~ :.I:q,licalr auJ uririn.d (~1~•d wil6 ('Icrk Circuit ('uu~t. BQII IIU~/IN'JIP w~lh Tat As~e~aor) -
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