HomeMy WebLinkAbout0630 p~ct~ru~~~n af ~a~iceEe a~td Citiz~t~~hip
'1'U 'I~I11: S'1'A~'I: ANU CUUN"1'1' 'I'AX ASSI :SSOR,
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ST. 1.UCIC - C'OUNTY, I~LnR1UA: , ~
'Iliis i~ my cl~~l:iralion of' l7umi4ilc and Citi•r.rnsl~ip ii~ thc Statc c~f Flarida that I am filing this day in
accorJancr, and in cunformity ~~~ith Sccti~~n 222.17, Florida Statutcs.
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1 w.~s forr.~crly a Irgal residcnt of _ , G~Y?-~' and 1
~c~~y (s~~~~)
rrsi~lcd at 1!4~~a?-~--~~ . llo~vevcr, I have changcJ my domicilc to
(Strert anJ Numbr~j r,I .
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and am and havc brrn a hons? fidc rrtidcnt of ihc Statc af Florida sincc day ot
, 19 2~, and 1 rrsidc at ----~~!le.-.Za. ~~G~v
(Slrccl a Numbcr)
~ _ i _ St. Lucie County, Ftorida,
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and tliis statcmcnt is to be taken as m~~ dcclaration of ritizrnshir, actual hgai residencc and domicile in tlie State
af 1=lorida.
(tnxrr: here auy prrlinrnt facts, such ac salr of proprrty or husinrss, or relinyuishment of employment at former
Jomicile, removal of famih• t~? new~ Jomicilc, purch:+~e ut home, elc.)
EP~TLRI?'G CHILDR~ti I;: SCHOOL: ~ HU~~STE.AD EXEMPT7U'.`::
If entering cliildren in school,
please list their names:
-.z. ~~.,l~~_~`_'~L~--~~
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~E1C~CQ_AO_E~ ~
RKCCI C111T~A5 r i
flf~~~ VERIFIE~ C~,~,~~~
i _ ~e 6 t14~ Pf!'15
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1 fUR7'1lER CI:R7'If~Y tl~at 1 K~ill re~ister .~t my local :~ddress when thc r~gistration Uooks reopen, and
coiz~~~ly ~aith all othcr rcquircmc:ris ~f a lr~:~l residcnt ~f this Statr.
1 I=11R..TH~:R CERTIFY that I h.ivc no intcniion to retiirn to my formcr domirile, and I intend to remain in
~ ST. LL'CII:
, County,
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~ 1;}~;ttf;ti~j111.~ ~ y.;. ( )
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, . .i . ? ~ fr:i S~ ~ r
t ~ . ` : . .GS~~ S A-'I'QRE
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S~vorn to anc~ sub::cribcd hcfor~ mr this _ day af
- - , A.1). 19_ ~J
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~ RCGER POI"fRAS, C1,LI;K CIkCUT"C C~llkT Flozid~
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I3 Deputy Clerk ,
(Tn bt e ~tWrJ in Juplical•• end ~~t~ytir:+l fil.•.: ~cith Clerl~ ('ircuil Cuurl. and Juplirate ~vi!h ~ .^~sut)
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~ BOOK
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