HomeMy WebLinkAbout1161 Deciaration of DomicE~~e ~nd Citizenship
3~?1~03
7'U 7'lll: STATI: ANU CQUN'fY 'I'AX ASSt:SSOit,
ST. LUCI~ _ _ _ COUNTY,1~ LORIUA:
Tliis is my dcclaration of Uooiicilc :md Citizcnship in thc St.+tc of Florida that ! an~ filinfi this day in
acconiancc, and in conformity ~yilh Scction 222.17, rlorida Statutcs.
1 was fonncrly a Irgal nsidcnt ot ~ /LL~~. , ~ and I
(c~~r) (s~.~~)
residcd at ~ rL°~~_ . Nowcvcr, I havc changccl my domicile to
(SUCet anJ Numlxr) • ~
and am and have bccn a bona fidc resident ot the Statc of Florida since day of
~ ' - , 19_--~
y and 1 nsidc at _5~ #~~~LL~~~~C~ ~o~ ~~s~
, ` (Stree and Number)
N . St. Lucie County, Florida,
(c~~Y)
~:nd this statement is to be taken as my declaration of citizensl~ip, aclual legal residence and domicile in the Siate
of ~~Ivrida.
(Inserl hrre any pertinrnt facfs, such u sale of pruperty or busincss, ot telinyuishment of employment at former
domicile, rrmoval of family to ne~a~ domicile, purchast of home, etc.)
r.P~TI:RI;~G CHILDREIJ IN SCNOOL: ~
If entering children in school, ~ ~
please list.their names:
_~nn n.
~z ~u~r~ 5~ %e
301303
i
~u°ci~ couM~irR~~i. .
- a~E~ ~o~TRA!
' c~,~,R~c c?k~un Qou~t _
Rf.COR~J Y[R FIEt~~~" - -
I 1 ~ 2 ~:M'75
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I rUR1'l1ER CFRTIfY that 1 will rrgister at my loc:~l address whrn the registration books reopen, and
comply ~vith all other requiremenis of a Icgal rrsidcnt of tl~is State.
~ t FURTHI:R Ci:RTII=Y that ! ha~•e no intcntio~i to rcturn ta my fornier domicile, and I intend to renfain in
~ ~~/l~i
SE~tJ ~t~-C-h _ _ ST . LUCI~
, , County,
~ Florida;~ic'r+i~alicr~Ny. cc•~~,~~
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n•L,l"` " y ~
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• ~I '
~ y. '
~ ,:?t,~ . : ~ - SIGI~I~?I'URE r
~ / : ~
~ Sworu,to ;(~ti1 s!?1
cetibcd bcforc mc tltis ~z__. day of
~ ~ x,~~~' ~ ~Z /sj
~ . A. D. 19-
~ ` .az ing ress
~ ~ ROGi'R OITRA. , CITKI: CIKCUIT CCi1}tT ,~"ENs~ ~~~h ~ rlorid~
~
~
~ Dy :.~~1~= (vuL-!`~..c.t~ II,, . ~ ~ le rk .
~ . .
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~ (To he rxeeuted in depGc,i~ ~,;i~ul f~1.J wilh Clrrk Cirr::~, :..:~rl. nnd duplicatr ~~~lh Tax Ascessor)
~ . ~~36 ~EZ1~~
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