HomeMy WebLinkAbout2850 Deciaration of Damicile and Citizer~ship
3~o~s32 .
TU TIIE: STATI: AND COUNTY TAX ASSl:SSOR, .
_ST. LUCiE! _ ~utv~r~r, r•~oRinn-r
Tl~is is my drelaration ot Domicilc and Citizcnsliip in thc Statc of Florida that 1 am tiling this day in
accordancc, and in conformity with Sectio 222.17, orida tatutcs.
. r~ _ ~
! was formerly a Icgal resident f~ , and 1
(Citr) (State)
rcsided at - ~ ~ . However, I have chan ed my icile to
~ (Street ~nd Numbe~)
and am an havc bccn a bona Cdc residcnt of thc State of Florida since ~ day of
' ~ ~ o ~a ~
, 19~~ and I resi at
" (Streel and Number)
^ ` ~ St . Lucie County, Florida,
~c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domiciie in the State
of Florida.
(Inseri here any pertineni facls, such as sale of pruperty or businzas, or relinquishment of employmcnt at former
domicilt. removal o( (amily lo new domirJe, pur:hue of Aome. etc.)
EP~TEItIyG CI~ILDREN IN SCHOQL: HOriCSTEAD ~XEMPTI0~3: ~
If entering children in school, ~ ~ ~
please list their tla.-nes:
' FILEO AND RECQR~ED
at. WCIE COUMTY FLA.
. ROCER ~OITRAS
CLERK Ci?tGU{T COURT. L
P.FCr.RG vE~:~ ~ED
~ 3 I ~ 38 AI~'~~ ~
i
~
i
; 30~632
~ ~
~
~
1 FURTHER CERTIFY ti~at I will register at my local address when tl~e registration nooks reopen, and
~ comply with atl othcr rec~uirements of a legal msident of this State. ~
~ I FURTHER CF.RTIFY that I liave no intention to return to my former domicile, and 1 inten~to remain in
~ ST. LUCIE
_ _ , _ , County,
Florida, permancntly.
~
~ ~ ~ J .
~ '
~ -
~ ~~~~uu~~a~~~~~ . S IGNATURE
O ~i f-'
~ Swor ~~C~c'c~,U~fotc mc this day of
~ a ; •~~~a c , • i•_ r : )
~ : • ~ . - ~ ,~c~ c
~ • . • A. D. 19~,~. l/
q -
i ng ress =
~ ~ ~~R~ ~ ~ -~K C CU I T C~URT ~ ~
, ~ _ . , Florzda
~ ' - • .
~ = s-.~ , /
~ ~ r.- '~~Gkj
~ By h, . ' puty Cl.erk :
,r~;
~ ~3 _ , _ • -
~ ~ `i(Tabe es' teJ in dupbcale and .xigin~i f~led wilh Clerk Circuit Caurl, and duptkate wilh Tax Asr:asor)
~ ~
~ $ooK~C!36 P~2847 .
~ _ _ - -
~.l ,1~ . ~:_y~"' ~ ~ _
'
~y ~ ~~Yr ` ~ £ _ 3 ~ .
. ~°'~.k_~.~'-__'^ a _4.
~ ~ s.. ~ . . e -".~~~~~s ~ ~'3