HomeMy WebLinkAbout2109 . . . . . 1f ~ ~ ~
Dectaration af Domic~~~ and Cit~iensh~p ~
f
s
• ~
"f0 Tlili STATG ANU COUN7'Y 7'AX ASSl~SSOIt, ~~~3 ~
ST. LUCIE COUNTY, rLORtI)A: ~ ~
- . ~
Ti~is is my dcclaratiun of Uomicilc and Citizcnshi~~ in thc Statc of Florida th~t 1 am filing this day in 3
~
acrorJa~icc, and in conforniity with Section 222.17, Fiorida Statutcs. ~
1 was fomicrl a le •al residcnt af ~l 7O ~ , U and 1 ~
Y b
(City) (slsfe)
resideel at ___.LS~ ~ ~?1~~' STon~ 12~c , fiowever, t have changed my domicile to
(Street snd Numbcr) '
a»d am and havc bccn a bona fidc rosidcnt of the St:~tc of rtorida since e b a~ 1~7~day of
- , 19___., and 1 nsidc at Ga ]_~1P~ r rJ ~ n v 2 T
(Street and Number)
_~__F~ ~ i E/Z~ . St . Luc ie _ County, Florida,
(c~~r)
a~~d tliis statement is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State
of rlorida. ~ ~,o ~-~J ~,e,~>
v
(Inxrt hete a~y perlinrn! facts, such as sak of ptopertY or businecs, ot retinyuis6ment of employmenl at fotmet
domicile, remoral of familY to ne~v doinicile, purchacr o( Aume, etc.)
\C HILDREN IN SCHOOL: I~OMCSTEAD EX~tiPfIOr:: ~
ENTER7 C ~ _ ~
If entering children in school, ~
please list their narr~es: i
~~s~ c~,S7~Nr sN - ;
~
~~~~ty c v~E~~ s~v~pE2
~s~~~
~1 Q I A~ E Q Yve s r S?v 1~ bE 2 ~R~~ ~
1tECQRC CL:C~ -"'r~
~ER~`~EO ~
. ~i 1~ 2 u p~ ,1S ~
~
3U~p7?3 - ~
.
~ . ~
R
E !
~ r
~ ~i
~ - 3
~
I FURT}lER CER7'IFY that (~~ril1 recister at my local address when thc registration books rcopen, and
comply with all other rcq~iirements of a le~al rcsidrnt ot this State.
~ [ FURTHLR CERTIFY that I havc no intention to return to my fonner domicile, and I intend to remain in
~ ~ LUCIE
C2 c , _sT. _ , co~~~~ty,
~ l~lorida, pcrmanently. (c~ir)
~ ~
l~-
. i
x
i
c:
~ '
~ $1Ci11~1~~
~ ~tf. Ua`~~' ~b cribed bcfore me this _ day of ,
~ Sw';~'S . •Y " ~-c., • ,s `'G~ ;
~ r,.~•` ~y ~ _ , A.D. 1y 7s? . ,
~ _ • ing ress
=..~pC,~'~~°P~~~1S, CLF.RK CZRCUIT COtTRT Florida
~ . : , ~ ~ ;
~ a 4, c,~'` ; - ~
~ . ,..~`'3~ ,4- `
~ ~r p • ,v DepuLy Clerk _ . . #
~ 1
~ ~
~ (To I+e ecWed in duplica~e anJ uriginal filyd wilh Clerk C~r~uit Cnurl, and dupli:•ate with Ta~ Asxssor)
~ S~K23fi P~2~4? . ~
~
- . - -
~ --=--y___. _ - ~
~ -
~ ~ _ = . _ _ . ~ u~