HomeMy WebLinkAbout2421 D~claration of Domici~~ ar~d Citizenship
TO 1'lit: S1'ATI~ ANI) COUhTY TAX ASSESSOR,
ST.~LUCI~ ^ _ __COUN1'Y, FLORIDA: ~
Tl~ic i~ my dcclaration of Domicilc and C'i~izcnship in thc Statc of Florida that 1 am filing this day in
accurdancc, ancl in confonnity with Scction 222.17, Florida Statutcs.
1 was formcrly a lebal residcnt of ~ ~l and I
~-c~~r) . (s~.~~
y~ /
resided at _^___1~1L_ L°~'~l~ls . Nowever, 1 have changed my domicile to
(Street and Number)
and am and have bcen a bona fide nsident of the State of Ftorida since ~ l day of
~~r ~ I 9_ and 1 residc at ~Lj'~ Ly~~~~ ~h ~-r- S T
(Streel and Number)
~~,~i____~~~r~ f~G(G!~° St . Lucie County, Florida,
~ (c~tr)
and this statement is to be taken as my declaration ot citizenship, actual legal residence and domiciie yn the State
of I~lorida. -
(Inscrt hrre any perlinr~t fatts, suth ss sale of prupert~• or businass, or relinquishmenl of employmont at fwmer
domicile. trmuval uf family to oe~v domicile, purchsu of home, ete.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD F.XEMPTIOI~:
If entering children in school,
piease list their names:
,
sf
.~°wW~ ~w,~r~ 1 {
ROCER a~ ~f
Cl£RK ~1RCt{lt~L
RECAR? YER~i1~~ ~
~i 11 9 ~ ~N'~5 ~
~
~ - 30~~
~ .
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i
E
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~
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I FURTHER C~K"TIFY that I will register at my local addmss when the registration books reopen, aod
con~ply with all ather rcc~uiremcsits af a legal resident of this State. ~
I FURT1tER CERTIFY that 1 havc no intention to return to my former domicile, and I intend to remain in
/'I ST LUCIE
~ - ~ -
~ O r~ S,* -,.1~. G[F County,
~ I=lorida, pennanently. cc`"'~
~
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~ G' •'y~U~~F_-i-,,', , ' /9'/Yt~loh r ~'~'kt-r i Net I (
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~ . Y' i L~ 4 j',; o;~: ~ S IGI~IATUR~
: cn 4 . ~i; r .
C, ~y
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~ -~wco 'b'~d before mc this day of
~ ;
~ ' ~x ~ A. D. 19 ~ w
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~ ROG1s'~'"~~'~2T . t:::. CLERK CIRCUTT COURT 1 ing res
~ S, l-f ~-~~t-.~-~ , Florida
T
~
By ~puty Clerk
' ~ ~
~ (To De t: v1eJ in duClicale anJ o~iyinal f0rd ~cith ('lerk CirruN Courf, anJ duplicste wilh Ts* AssesuK) ;
~ So~236 ~2418 ~
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