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Declaration of Domicile and Citisenship
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TO THE STATE AN~ COt1NTY TAX ASSESSOR~ ~
Sl. lUCIE GOUNTY. FIORiDA:
This i: my declarstion of Oomicile and Citizer?ship in ths State of Florld~ that 1 am filinq thit day tn aooordano~ u?d ~
in aonfomnity with Chapter 2~2. Ssction 2Z2.17, Florids Statutet. ~3`
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I was formerly a leqal roside+~t of " ~a») -
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m domid~e s:
and 1 nsided at 36 U=~~~LtrA ROAQ . Hovwver 1 have charpac! Y
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(Street and Number)
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to and am snd heve been a bona fide resident of the Stste of Florida sinos - y t,
! 164 sole z A~e Port St. I.ao i s
April , 19_.~ snd I roside at _
~ (Street and Number) x~
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, Fo~r M~, snn~ iuci~ couNnr, RORIDA
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, and this statement is to be taken as my declaration of citizenship, sctual Ia~sl residenoe and domidle in the State of Fbrida.
or businea:, or relinquishment of employmsnt
pnse~t hero any pertinent facts, sud~ es sale of PraP~tY
+ at former domicile, removai of family to new domicile, purchase of home, etc.) -
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,ppl~ing !or home~te~d . ~
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F;~ L~ e ST. LUCIE COU4TY, FLOR d
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~ I FURTHER CER?1FY that 1 will register at my local address when the re9istratwn books reopen, and oomp~y with
I~ e11 other requirements of s le~ai rosident of this State. ~
' 1 FURTHER CERTIFY that 1 have no intention b return to !ny former domicite, and I intend to remain in FORT
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f PIERCE, SAINT WCIE COUWTY, FLORI~A, permanentiy.
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~ 4' 15th - Jeanesq - t9 ~
Sworn to and wbscribsd befor~ rn~ thi: - ~Y ~ ~ r~
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rO1TRAS Q,. K : yr.
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CIRCUR ;.r y .'-v ,i?~; ,~:.'T., : O
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-(Te b~ s~arNd iw dupUCah aed Ki~ie+l'ft~d.~1!~-t1l~'.CireuN Cou~, and dupiiut~ witb Tax /Iw~erJ
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