HomeMy WebLinkAbout1664 D~c~ar~ti~n of C~c~rni~~t~ anc~ C~itiz~nshi~ /
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"fU "1'lll: S"['~~"l l: ANl) ('OUN7'Y '1~AX ASSI~SSUIt, ~
ST. LUCIE
couN~rY, r•~o~tiu~:
Tl~is is my drelaration of Uomicilc illlO C'itircnship in thr Statc of T'lorida th;~l 1 am tiling lhis d~y in
accuntanc~, and in conformity with Scction 222.17, 1=lorida Statutcs.
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I was fonncrly a hgal residcnt of ~ and 1
~ (City)~~ (state)
residc~l at . HoH~rvrr, I havc changcd my domicil~ to
(Strcct anJ Nu rl
and am and have tx~en'a bona fide r.sident oi Ihe Statc ~f I~forid.l since day at'
, 19~5 and 1 residc at ~ ~ - t~ , _
~ (Strrrt and Numbcr)
r , Sr . Luc i° County, f
lorida,
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.~nd this statemcnt is to b~. ta}:en .rs m~~ decl.~ration of citizenship, actual Iegal residence and domicile in the State
of Florida.
(~nser~ here any prrhnrnt facts, such as v!c o( proprrly or Ausinrss, ur rctinyui~hment uf emplnymrnt at former
dumi.ile, rrmwal uf farnih to ne~r dumicilr. ~~urchrst uf ho!ne. etc.)
Er2'CER?~:G CHILDRE:: Iti SCH00~"i HOr~S~AD E~Ch1PTT_0^:: ~
If enterin~ children in school~
please list their narres;
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' 1 FURTHt~.lt CF:R7'11=Y that 1 will re~~ister at m~• I~r,il a:ldr.ss when the rcrictration books rop.n, ai~d
~ con~{~ly ~vith all ot}l~r req!~iremt nts c~f~ a le;~al rrsiclent of this Slatr.
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z I FIiRTHI:R C'I:fZ 'IFY that 1 l~a~c no intcntion to rrturn to m~• form~r domicile, and ! intend to m~;iain in
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; ST. L!ICI~
s v,~,,~,~ Ccunty,
' F!o~icla, pcnnanrntly. - (c~~y~ - -
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O~ . SIGN7`~TURE~ ;
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i' ~SU~s. ~ ifird hcforc n:c ,i;i~ da~~ of
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R~GER••'~'OI'['itAS, CI.EI;I: CIP l1T COU1:T
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1;; ~7' cru~y C? erk
(T ~ hc ezr rJ in ti~q~5r:~tr r~nd ~~ripin ~l htrd ~~~~h ('Irrk ~'inuu C~~ ~r1.:11t1I,U1'Ill'81t K'llll i• -~>u~)
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