HomeMy WebLinkAbout2794 . .R . . . ~ / ~
pei~arat~on of Q~mac~~~ anc~ C~t~z~~~h~p ,
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7'U Tlll: S~'ATI: AI~i) COUI~!'1'Y "1'AX ASSI~.SSUR, ~
ST. LUCIE_ __COUNTY, t~LUR1UA:
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11iis is my dcclaration c~f vomicilc and Citi•r.cnship in thc Statc of rlorida that I an~ (iling this day in
c~ccor~lanc~:, and in coniormity H~ith Scction 2?2.17, Florida Stahitcs.
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1 was tonncrly a lcb~l residcnt af , ~a- • _ and 1 ~
(c~~y) tsu~~~ I
r~ sidcd at .1~_i~~~~__ _ S~_ ~K r~~ , Howcvcr, 1 havc ch~nged niy domicilc to 4
r++~ trcrt anJ Numbet) ~
and am and havc bren a bona (ide residcnt of the State of rtor.da since day ot'
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-~h.~ - 19_~~_, and 1 residc at~d S•7~S~f ~6
~ ~ (Strret and Number)
e ~G S~ . Luc ie County, I'IOllv:l,
(city)
.~nd this statemcnt is to be tc~k~ ~r as my declaration ol' citizenship, actual Iegal residence and domicile in tiir State
c?f Ftorida.
(Imrr: here any pertinrnt tacts, such as salz of proprrty ur businrss, or relinquishment ot employment at former
domicilc, nmoval of family to nr~e Jumicilr, purch•rsr of home, clc.)
I;?'~`CCR1`<G C~II1.i~RE?: II~ SCNOOL: ~ NON(ESTEAD F.X~MPTIO~:: ~
If entering c}~~ ldreii in school, L=1
please list ~heir nar.:es: ~ ,
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~t~r-~~`-'~--- ;
~r r t ~e, . TQ~~tco J
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f ~E9 ANO REtpRp~ ~
i~. IUCIE COU!!TY f1,A.
ROCER POITRA3
' ClERR CIRCUIt COURT ~
' REC4R0 V~ittPIEO
~M I~ Z F3 PM'~S
' 3~4
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~ 1 FUR'I~t1ER CL:RTIi'Y that 1 will rc~istcr at n~y local address ~vhcn the rcgistration books rcoPcn, and
comply wilh all othrr req!~iremcnts of a Ic~:al rcsidcnt of this Statc.
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~ I FL1RTfil:R CI:RTIFY that 1 ha~•e no intention to return to m~~ formcr domicile, and I intcnd to remain in
~ ` ST. LUCI~
~ ' - C:out:tY,
* I~IoriJa, pcnnanrntly. ~c~~r)
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,``•~~i~il,tuq~ry" , :.Y _ _
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g : ~``,9` SIGI1Al'UR~ -
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~ ~ S~ n to atiSl~~1i cr'~~ i~~cfa~r mc this ~ da~l of S~ ~ s*,
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i ing~~ r, s
~ 'R` ~•~9 ~ CI.T:I:K CI kCUIT COURT
~ • ~ ~ _ ' ~i~rG~ rl orida
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~ I3y ~ ~~v~ n~~!tty C] erk -
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(Tu t+c t~r~ dnph,alr anJ nri~ inrl f~IrJ ~vith ('Irrk ('ircuif ('uutl, and duphcalc wilh "lafc At~esuK)
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~ BOOi~ PACE~~
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