HomeMy WebLinkAbout2795 D~c~~rat~~n at cor~ic~~~ an~ Citiz~n~~~ip ;
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"I'O'I tlt. S'IA'1'I: ANU CUUn"Tl' 7~AX ASSI~.SSUR, ~
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_ ST. LU~TC - c~ouN~rv, i~ LUltll)A: - 3~~~~
Tliis is my drrlaration of I)amiciir :~nd Citircnship in thc Statc of C7orida that 1 atn filin~; lhis day in
:icranla:~~c, and in ronformity with Scction ''22.17, Florida Statutcs.
1 was formcrly a lr~~al residcnt af --~~llSLs~___ ~ c~~ e- , N~. .Te~s and I
cc~~>~) csui~~
resi~icd at _3/D Sr,e..1.~I o ~P . Howcvcr, 1 liavc changcd my domicilc to
(5ireel anJ Number) ~
and am a~~d havc Ix~cn ~ bona Cdc residrnt of thc Statc of t~lorida ' sincc ~
S day of
- ~o ~ev_n ~e ~ _ ~ ~/~-J _ J6..~r~ e.r ~r .Hia
19_7 and 1 rcsidc at ~
• (Sir et and Number)
_ l~_ r
7' L~e - S t. Luc.ie - - Count
Y. Florida~
(~'~~r)
:~nd this statcmcnt is to br taken as my drelaration of citizrnsh:, , actual ic~;al residence and domicile in the State
uf rlorida.
(Insrri hrrr any pcrlin~nl facls, sucl~ ac sde of pmperty or busincss, or relinyuishment uf employment at former
domicil., rrmnval of family ta ncw domicilr, purchasr of homc, a tc.)
L•'~'~L•'RI~~~G CHILDREI: IP1 SCHC:IL: ~ HO'.~(ES'TEAD ~XI':MPTIO:~:: '
If entering childreii ili school, ~ `
pl_ease list their nsj~es;
1LEO ~t D AE~p ~
' ~i•~~COUMT1r~u,
CLEAK C1 CU1T~~ o~
~EC4A~ Yf R~FIEO c.,.,.r,~
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€ 1 FUKTIll=.R CF:RT11~1' that I~vill registcr at my loc~~l addmss ~+~hen the rcgistration books reopen, and
~ ro~npl~~ ~vith all other rec~!~iremrnt~ of a Irgal r~sident of this State.
t
~ I 1~URTHGR CERTIFY that I ha~~c no intcntion to rcturn to my forn~cr domicilc, and I intrnd to rcmain in
t ST. LUCI~
County,
~ ~~larida, Perni~?~untly.---- ~c'`,~~- - - -
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~ Sqto~f~t;t~cl~n~su~t'rbed bcforr mc this ~ o_ day of
~ ~ ~ O ' - - A.D. 19__ ~ -
~ - - ' ~ ~ ~rg ress
~ i'~. :R POITRAS, I.ERit C1RCL'1'f COURT
~ _ _ , Florida
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= Ceputy Cler.~: -
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(To bc r. uled in dnplir~tr anJ ori,:ur.J f~Ird a~ilt~ ~'Icrk C'ir~~ii1 Cuurl. and dupliralr wilh Tax Assr~s~tt)
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