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Declaration of DomiciJe Gnd
~b~i 5 503
Citizan~hjJl "'----
~T. CUClE COUNTY. flA.
TO TIlE STl\TE AND COUNTY TAX ASSESSOR,
S1'. LUCIE COUNTY, FLORIDA:
Thia ~ my declaration of Domicile and Citiunahip in the State of Flolida that I am ftli'l' this day in
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accordance, and in conform\tJ with Chapt4!r 222, Sectic:>D 222.17, Floricia Statutes.
I was formuly a le_,lluident of,________~,~~~~~.9______..'m______un____'_____________, ____~_~!~____u________
(CitJ') (St.a&a)
and I reaiced at..____7.~~___~~,s.~m_~!e n__u_n__um'_n_______.____,m______" However, I have ehanpd my'Yaomicile
(Street aDd Number)
to and am and have been a bo!l& fide resident of the State of FloriJa since.____, 6tl1.__u__u,_ ___nm__ day \}f
_u,___~~_~~,~___.____n_______u,__.______,._u,' 19m~~' and I reaije aL__n_~_~~___~'~_n~~~h __~~_'u______'n_____m.._______._,__,
(StrNt and Number)
ST. LUCIE .
.__....__,.__' __ ____n_ ,___nn_unn_u________,___.'_____ __County, Florida,
FT. PEl RCE
u_ _n____u,___n_n,n__m'______i Citii-- ,,-, ,,_nn____.u_m "
and this statement is to be taken as my declaration \}f citizenship, actual leg-al residence and dOf.llide in
the State of Florida. -----,-
(Insert here any pertinent beta, auc:h &II ..I. of r:.oilerLy or bllam... or rtiinquiahment of eICplo)'meDt at
fo. mer dowieUe. remo,...l of f~ly to new domlel e, purrb... of home, ~.)
Entering
ONE (1) chi1d--PAUL ROGER ACKER-- 3rd grade
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I FURTHER CERTIFY that I will register at my local address when the registrati\}n books reopen,
and comply with all other requiremEmts of a legal resident of thil'l State.
I FURTHER CERTIFY that I have no intention to return to my fonner domicile, and I intend to remain
in. ___u__ ___ ET._ __ Pl..ERCR._ ,___..__._ ._n_________n_____ ,_u_.._m, __nun_oS T.a.u_L.UC.lEu ___n.__u _u_____ u_' -- County, Florida,
(City) n _ L
pennanently. ___.~-:-:.-'---n_~~~-..,-------.'.,---m.
(Name)
AUDIE ACKER
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(Adchul)
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swo~'~ and ~bed before me thilL_ulYuday of
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(1'0 be txKUW In du!,>licate and orl<<fnal flIed
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