HomeMy WebLinkAbout1662 Deciaration of D~micile and Citizenship .
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~'U Tlil: S"fATG ANU C'UUNTY 1'AX ASS~SSO{t, j
ST. LUCIE ~ 3Q~-~~s
_ COUN7'Y, ~LORIUA:
Tl~i~ is my dcclaration of Domicilc und Citizcnship in the Statc of Florida that I am filing this day in
accor~ancc, ancl in conformity with Section 222.17, Florida Statutcs.
1 was formcrly a lcgal residcnt of " , ~~-r ' and 1
(c~~r) (s~,c~~
residcd at a~ ~ . Howcver, 1 havc changcd my domicilc to
(Stttet snd Numbtr)
and am and have bcen a bona fide resident of the St~te of Clorida since ~ day of
19__y and 1 residc at ~s M r d i~~e ~~a n ttl
(Street and Number)
psi t Sr.. ~t c I,e St . Lucie ~ County, Florida,
(C~i~ )
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicite in tlie State
of Florida.
(lnseti here any prrlinenl (actc, such as sale of property or bus~nrss, or relinquithment of employmeol at tormer
dumicilt. remo~•al of family to neN~ domicile, putcl~ase of home, elc.)
ENTERING CHILDRE?3 IN SCHOOL: HOMES1'EAD EXEMI'TIO:y: ~
If entering children in school, ~
please list their names:
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~ 30~'~06
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~~~co~~, ~
aacER Po~~w?s i
; CLERK CiACWT COltRT ~ _
~ RECORO MERtFiED....~~
~ ~ei9 233P r
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~ I FURTHER CERTIFY that 1 wiil register at my local address ~vhen the registration books reopen, and ~
~ comply with all other reqtiirements of a legal resident of this Statc.
~ I FURTIiER CERTIFY that I ha~c no intcntion to return to my fomier d~micile, and 1 intcnd to remain in
~ jt'o~7-Sd-. L N~,~ ST. LUCIE , County,
~ Florid~~rmancntly. (c"''~ "
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~ . ~ . = '~-SI~ATIIK
p w i n~ ~ L ~
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~ - . _ ~t. : ~ , S IGI~iATURE-
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~ Svi~orn:t,^,aii suhscribed beforc mc this _ day of
~ ,~i~ r~~
. . . . ~ _ n. n. ~ 9~.
~ i ing ress
ROG~R POITKAS, CL RR CIKCUJT COURT Florida
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II (O Deput Clerk " ^
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~ (To Me e:eculcd in duplicatr anJ oriKinal fiird wilh firrk Circuit Coutt, and Juplicale ~vith Tax Assesux)
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