HomeMy WebLinkAbout0524 Qvclar~~i~n of ~~r~ni ;~~e ~nd Ci~iz~~ship _
~ooess
~IU 7~11[: S'fATI: AnU COUN'fY 7'AX ASSI~SSOR,
ST, LUCIL ~•~uN~rY, r•~oitiun:
Thi~ is my drelaration c~f Uomicilc and Citiz~n.hi~~ in thc St:~tc of rlorida that l am filin~ this day in
acconlan~c, .~n~l in canforniity with Scctiqn "'2"'.17, Florida Statutrs. .
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1~~~as formcrly a lcgal residcnt of ' r_l~n~~~_`_ ~Z''(`Yh~~(1
- , and I
(CiIY) (Slat
rctii~ird at _~~a~~(!"~v~~r Sir`__ __~~~~sE~r Howcvcr, 1 havc changcd my domicilc to
(Strrrl and Number)
.ind am and have bccn a. hoiia fiJr residcnt of thc Statc af Florid.~ since day ot'
_C~'PC_.'Q`LY~
~~Y`_ , 19Z___L___; an~ 1 residc at ~~1~`~~~__~~~~_!'1 (,P!"__~,
(Strcet and Number)
L1'• _ ~ ~_1!' ~ `Q _ _ - . St . Luc ie County, ~lorida,
(c~~~r)
;:nd this statrmrnt i~ io bc takcn as my dccla~atibn ot citir.cnship, actual lcgal residcncc and domicilc in the Statc
ut' i~lorida.
(Inuri he~r any prrtinent iactc, ~uch as sale r~f pruperty or businrss, ur relinyuisl~ment of emplnyment at former
domieilc, rcmural u( f~mil~• to ne~v domicilc, purchasr of humc, rtc.)
E":'fERI",G CHILDREr.' It1 SCHOOL: HOMEST~AD EXEhiPTI~i'.'i: ~
If entering children in school, ~ ~ =
please lis~ their names: ` ss
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~ 1 FURTIIER Cl:K~rir-~' that 1~vill rrristrr at my local address whcn the registration books reope~i, and
~ con~ply ~vith .~U athrr rcq!iircmcnts of a Ir~;al msidcnt of this Statc.
~ 1 FUR1'l1ER CL'RTIPY th:ct 1 ha~~c no intci~tion to rcturn to my forrncr domirilc, and 1 intcnd to rcmain in
{ - - - - - - ST . LUC I~T--
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g ~S~vurii,~ aG~subscribr.l hc•fc~rc ntc ti~i; ._L_.---- day of
~ _ ~?~~c~{.3 c - , A.I). 1 ~r_~ ~ ' ^ `Y ~ - hJ~-t..ar ;
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~ R~GI,R F TTR!`.~, .,LERiC CTRCUI f COU1.T r_ , rlorida
~ ~y ~-l-~-t-- ~''~l-~~ ~c~~uty Clerk
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~TU ~M QRtCUICII 11! dup:~c:~lr anJ ~•riFin:J fJ~~d with Clrr{. Circuit ('~~urf. ~uJ Ju~i~.•:.rc ~~~~h ~t:• .~.•,uu)
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