HomeMy WebLinkAbout0556 ' Dectara~t~r~ Dc~mic~~~ a~d C~tizen~~ip ~ ~
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7'O Tll1; S'TA'1'I: AI~U C'OUf~ IY '1'AX ASSI:SSUk. ~
ST. LUCIC CUUN"I'Y, FLUItIDA: ~Q:~~.56 '
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'Il~is is my ~lrrlar;ilion of vomicilr and Citirenship in lhc St.~tc af rlorida that 1 am filing ihis day in
accar~lai~cc, and in confurntity with Scrtion 222.17, [~lorida Statt c° . ;
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1 wus fonncriy a lc~;al residcnt ot' ' _..i_ ~ and I ~
(ci~. ) (statr)
m~i~icd at . Hawcvcr, 1 havc changed n~~~ domicilc to
(Slreet and Numbrr) p ~ ~
and am and h:wc bcrn a bona ~dc rrsidcnt of thc Statc of Flurid.^. sinre L'~~~ day of s
y L~, ~C} . ~75 ~ ~"i7~ ~ `
1~ ~----f, 19-------, a~~d I residc at
v~ , (Strret auJ Number)
' --st_. _~.ucie - Coanty, r•iori~~,,
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.?nct tLis st~temri~t is to be t.iken as my derlarition of citizenshi{~, actual ieg~l residence and domicile in the State
of F=lorid:~.
(Insar: hrre any pertinrnl tacts, such a. s:J~ uf prupe~l~• ~~r bucinris, or relinyuishment of rmploymrnl at former
Jumicilr, ~cmo~al uf family t~, nc~v domicilc. purchax uf I~umr. ctc.)
Ef`ITCRI;:~ Ci~ILDREN I;i SCE~OOL: " HO?•tESTEAD E.~~1PT1U`I: ~
If enter~_ng children in s;.hc~o:.,
please ].ist L-heir names:
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; f~~p ~pn 9ECi?RDEO
tT. LUCii. ~OUNri ftA.
~ R~CEF f~QITiIAS
f ~Ei~t, C;?GUIT C4URT
~ RFG~~O YER'f;EQ~~'~
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~ ~0 It 4s AM'75 i
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~ 1 rURTIlt;R Cl:RT1T~Y that f„•i!1 re~~i~t•.•r at niy local a~lclr~ss whrn the rcgistration booi:s reopen, and
5 comply H~ith all oth:r r~q!iirrsnrnts ~f a Ic~al resi:ic•nt of this Statc.
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~ ] f~UR7'I~I;R CI;RTII=l' that I h.~~~c n~ intc~itic~n to rcturn to m~~ furmcr domirilc, and l intend to :cmain in
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ST. LUCI~ '
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l~lorida, ~crmancntly ic~~,~
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'~.~:orn t i;t+Y~Iftu - urr n~c tiii:;~~__ day crf ~
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ROG~F PCsT i RAS~1 ~~I~:gK CI UTT CO[lRT rlorida
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By . cp,~~y ~C..er~, ~
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...,(~O e r•cc rJ in duplic±lc :;nd •.ri~in iI L!rd KiU~ CI,•rt: (~rcu~~ ('uurl. anJ duplicalc wilh Tax A~xsax) ?
aooK ~7 pa~ 555 <
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