HomeMy WebLinkAbout1042 Declarat~on of Dornici~~ and Citizen~hip
'i'U 7'H1~ STATL ANU CUUN1'Y 'fAX ASSI:SSOR,
ST. LUCIC ~•UUNTY, FLOR11)A: ~
- - - ~
"Il~is is my dccl:iration af Uomicilc and Citi~cnship in'the~ Statc of F7~rida that ! am filing this day in
a~c~~rdancc, and in canformity with Scction 222,17, Florida Statutcs.
1 was farmcrly a lcgal residcnt of _ ~n Pn.~.s'~ ~~I~ ~A_. and I
,
(ci~r) (st.tc>
residcd ut _..Z-~'
-_.~.~~.~_NS ~ e- . Nowever, 1 have changed my domicile to
(3trect and Numbcr)
and ~m and ha~c bcen a bona fid~~ resident of dic State ot Florida since day of
~.Q..~o~~~ , 19_ 1.~,,._, and 1 residc at ~ T r~ mc.. V t 5~~. ~~J~ ~
~ (Strcet and Number)
~ -t-O 2'~ ~~t°_'~C-Q _ , _ St . Lucie County, Florida,
(c~~r)
and this statem~ nt is ta be taken as m~~ declaration of citir.enship, actual legal residence and domicile in the State
of Florida.
(Inscri here any {xrtinent facts, such as satr uf pn~perty or business, or rclinquishment ot cmployment at fotmer
domicile, temu~'al ot famity ta ne«• domicile, purchase of homt, rlc.)
EPI'fERI":G CNTLDREII IN SCHOOL: HOMESTEAD EXEhiPTIO~y: ~
If entering children in school, ~ ~
please list their names:
' ~ ~
- ~T• WC1A~~01IMTY ~ :t
Ro~e~ Pa~tn~a f
' ~ RI~QRD yCPt~Ep
' J1 9 s9 AM'T5
; }
~ ;
~~~I~ F
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~
~ I FUKTH};R CERTIFY that I will register at my local address ~vhen the registration books reopen, and
~ compl~r with all othcr rcqtiirements of a lrgal resident of tilis State.
~ I FURTIIER CERTIi=Y that 1 havc no intciition to return to my formcr domicilc, and 1 intcnd to rcmain in
~ ST. LUCI~
~ ~ ~ v C~. _ - , CountY,
I~lorida, pcrmanently. (c'"•~
~
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y .i~.y~;~, '?,s..~
~ '.ar*~~~ ,'C'/`'~ _"~r; _
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c; -Si~''.~.'c,•: y= .
' ~~:].-.i~~~~ ` ~ : ~ ~ SIG:~1ATtlRE
# " • y ih~~IR.~: ~ ~ ~
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~ Sriror't~~_=~t}t~~t~N~c`~ribcd bcfare mc this Z day of '
~ : . ~ ~IS~
, ,
, ~ 7S- 'J5~ E 1Y~n~
~•u a'~ , A.~.
~ - ' ~ _ . a~ ing ress
~ ROGI:'~''~OI'IRAS, CI.ERK ('1 RCUTT COURT {~j S~ •~C / t' ~ rlorida
I~y Deputy Clerk . , ,
,
r
~
.«41 • -
(To Me exet ed i~ i~r and original f~lad ~ci1h Clr~k Ci~cuil Coutl, ~nJ duplirate wilh Taz Ac~essnt)
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~ ~0~236 ~10~
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