HomeMy WebLinkAbout1057 Declara~fQn of [~amicit~ and Citiz~nsf~~p t~ ~
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~~O 1~Ht: S7'A'I ANU ('UUN7'Y TAX ASSI:SSUIt, ~~4~"~
ST._LUCIE ` ~•OUNT~~, ~LUKIUA:
'ilii~ is nty dcclaration of Uomicilc .u~d Citizcnship in thc Statc of i~lorida that 1 am filii~g this day~in
accor~lancc, and in conformity with Scction 222.17, rlorida Statutcs.
I was fornicrly a Icbal residcnt of ~YIQ _ _ and !
^1 cci~r) cs,~~~
residcd at _ ~ . Howcvcr, 1 havc changcd my domicilc; io
(St~cet a~d Number)
and am and havc bccn a bona fidc resident of- tl c State af rlorida since -~-'i== day of
_C~~- , 19_~, and 1 reside at
(Sirect anJ Numbcr)
~ St . Lucie _ County, Florida,
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(c„r)
and this ttateiiicnt is to be takcn as my derlaration of citi•r.enshi~, actual legal residence and domicile in the State
of Florida.
(Inxri here ~~y prrtinrnt faNc, such a~ sal. of proprrly or husiness, or f~linquishment of employment al formar
domicile, removal ut famity to ne~v Jumicilr, purchase uf I~ome, etc.)
ENT~RI~~G CHILDRE*d II~ SCHOOL: NnMES'TEAD E~:Cr•iPTJO'.: ~
If entering children in school, ~ _
pl. t~se list the~.r names :
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FIlEO ANO RECORDED ~
ST.IUCIE COUMTY f~A.
- ROCE~t POITRAS
CLERK CiRCU1T COURT
RECORD VERiFIED~
~r 11 1019 AM'15
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~ - - 3t~1+2+29
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~ I rURTHER CERTII~Y lhat 1~~-ill rcrister at my local address when the registration books rcopen, and
~ romply witl~ all other reyuiremcnts of a Ie~al resident oi' ihis State.
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~ 1 FUR'I'IiER C~RTIFY that 1 h:tvc no inte~~tion to rcturn to my fonncr domicilc, and [ intcnd to rcmai~: in
~ LUC i~
L SL•
- , - - , countY,
~ I~lorida, p~rmancntly.
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~ ~~1..~. `J , •I ~ - - •
_ ~ ' • NAT'ITR
~ t ~ - -
~ . . ' - , . • 't' ~ ~ = S IGIIATURE
~ -:;:::sL: .;,j = -
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~ ~ SH!orn T<~~Ce~ ~ubficribcd bcforc mc thiti __l day of .
~ ~;~~.`XG~ ~
~ ~ 7 A.O. I 9 ~ Q~ ~ ~o~ !7
~ i~ing ress
~ ROGFR POITRAS CLEIi~: C7}ti
t~17' COURT
~ ~ ~ rlorida
~~~~1 r
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~ IIy Dc,Puty Cler~: ~
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~ ( o b~ a rculed i~~ Juplicalr anJ oriKin.d t~IcJ ~~ith ('Irrk l'itcuit Cnurl, anJ doplicalc Ni~h "T,~ A~cruor)
~ ~ ao~236 ~1U57 ~ _
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