HomeMy WebLinkAbout1698 ~ . . . . . y~ /
Declarat~on of [?~micEle and C~tizensh~p
7'O Tllt: STA~'l: ANU COUNI~Y TAX ASSL:SSOit,
ST. LUCIE ~1 ~a3~
COUNTY, f LO1t1UA: ~
Tl~is is my drelaration of I)omicilc and Citi~cnsl~ip in the Statc ot Florida th3t 1 am filing this day in
accorclance, an~1 in confonnity ~vith Section 222.17, Florida Statutes. ~
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1 was fornicrly a Icg~il residcnt of ~Uss~4 , D i~~~o~? and 1 ~
(ci~r) T (saee)
resided at ~~1! - . However, 1 have changed my domicile to
(Sireet snd Numixr) _
and am dnd havc bci:n a bana fidc resident of the State of Florida since day ot
19~~, and 1 residc at _~7oJ ~a 3.~~~. si ~~inev~e~ D~~
! (Street and Number)
. St. Lucie Coiinty, Florida,
- (c~~y)
1nd this statcment is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State
of Florida.
Qnceri here any prrtinrnt facts, such u sale of properly or businrss, or telinquishment of employment at fotmer
dumicilt, remu•~al of family to new domicile, purchax of home, etc.)
ENT~:RI~G CHII_DRC?~ I?d SCHOOL: ~ HOMES'TEAD E~iEMPTION:
If entering children in school,
please list their names:
FN.ED A110 RECOROED
ST.~tIC1E COUMTYft~ ~ '
ROCEit ?vITRAS i
. CtEa~c c;~cuir covRT ~ {
RECOR2 YER!FIED
. ~e 1a i019 ~M'15
- - 30'!.~'35
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~ 1 FURTIIER CERTIFY that 1 will rrgister at my local address when the rcgistration books rcopen, and
~ comply with all othrr req~.airemcnts of a lrga! residcnt of this Statc.
~ I PURTHEK CERTIFY that 1 ha~•c no intention to return to my former domicile, and 1 intcnd to remain in
~ ~i i~ei-~~-- ~ ST. LUCI~ _ ,
CoGnty,
~ Florida, pcrmancntly. (c'~''~
e
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tti~; : ,s ~ SIGI~IATURE
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r - Si~qrfi:to an~.~~r~ficd l~eforr nz~ this v day of
~ . - : _r•~,,;.:-
~ _`~~'~-'.1~~~G A.D. 19 7~_. ~
~ i ii~g ~.ress
~ ROG~R POITRA CI.~RK IRCIiZT C(~llltT ~
~ ~ _ , Fl~rida
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IIy ~.t catit~ Clerk ~ ~
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u (To Fx rxrc Itd in dup!icale and oripi~i:~l filed with ~'letk l'ireuM G~utl. ~pticate Nilh Taa Ascessut)
~ eoox~ r~1697 ~
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