HomeMy WebLinkAbout0777 Declaration of t~omicile ~nd Cit~~~ns~crp ;
~f' ~
~
"f0 THI: STA~'1: AND C'OUN7'Y 7'AX ASSL•:SSOR, ~~O`~~ '
ST. _ LUCIE_ _ t~Ut1NTY, H LORIUA:
'I7~is is my dcclaration of Domicilc and Citizrnship in thc Statc of T lorida lhat I ant liling this da}• in
accor~lancc, and in conformity with Scclion 222.17, Florida Statutcs.
1 was formerly a lcg:~l resident of ---1 ~r
iTT •v•v ~~ll~and I
cc~~rl (si~~~~
residcd at ~_~L L C~_~ . Howcvcr, I liave changcd my domicilc to
(Streel snd Numtxr)
i i
and am and havc txen a bona fide residcnt of the Stat~ of Florida since ~°l~ day of ~
~
!1~4~---_ , 19~~~ and I residc at ~1_ s~ ~~Q D A__~y~7
(Strcet and Number)
_S~~ ~ _ . St; . Lucie _ County, Fiorida,
(c~~~•)
;:nd this statcment is to be taken as my declaration of citizenship, actual legal residence and domicile in thr State
of l~lorida.
(Inser: here any pertinrM facts, such az s:dr of property ot business, or relinquishmrut of employmenl at tormer
domicilr, rrmo~•al uf family to ne~v domicilr, purchase u! h~.m~, rtc.)
ENT~RI~1G CHILDREN IN SCHOOL: HOMESTEAD E~EMFTION: ~
If entering children in school, ~ ;
please list their names:
~
~AIL£D 1?N L~ ~tB0~11D~
~ ~0 En Ppit:Ail~ ~
'GL£AK C;e~IT ~DIA~ :
RECOR~ +Ei:~'1EO~..,.~r.~3-~ {
i
~ ~ l~ ~ s1~ ,
~
' i
~
~
~ ~3~
~
f !
k
i
e
3p
C
5
~ 1 FURTHER CERTIFY that ( will register at ~ny local addre~.s ~vhcn thc registration books rcoprr., and ;
= cornply witi? all otlier requirements of a lc~al resident of this State.
~
s 1 FURTH~R Ct=RT f~Y that 1 ha~~c no intcntion to return to my fornier domicile, and 1 intend to remain in ;
~ , :
~ ST. LUCIE
- - County, ;
- I=londa, pcrmanently. c~~tri 3
3 ' ~
- A~'UF.E l
= - ~"~-1 ~ ~~p
~
d ~
~ S IGI~ATURF: ~ _
- ;
~ C11)' OI j
.F Sworn (q,~lr&~yy~cribcd bcforc mc this s
_ ~~i.~' ~4 J` .
- ~J • I
A.U. 19-----• ~
- :'v : z ing re s s ~
_ •
- =~t06~_~;.~~~1'_ ' :CI.CRK CI CI;IT COURT ~
r • ~ ~ ~ ~ : , Florida
~ : ~ Ya +~t''
; ~~,~r'• ' j'~' e~:~ty Cl.erk 3 3`~I 5 7/
_ . .
- ~ : . -
~ . - ~ ;
:
.g i-f #il~ tx exetul in duplic~lr anJ oriRinrl f~lcd,w~ilh ('Irrk Circuit Cunrl. anJ Auplicatr w~lh Tax Assc~
s , ~~i.~~/!~~r.~..•~~t _ .
tG . ~ . ~ . sooK ` ~37 PA~ 776 ~
~ ,
_ - . - - -
n 4 , . . j . . _,s°,..
. ~
t
~ _ 3
e.i..,.. :.-N-\ t . . .