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De~clairation of Domicile and Citizenship '
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;
. 2~7'429 . `
TO THE STATE AND COUNTY TAX ASSESSOR, ~
S t. L u c i e ~pU~y, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
~
I was formerly a legal resident of ` and I
(Ci ) ~ (StaN)
resided at . However, I have changed my domicile to
tsa~.: ~a N~~c~) .
and am and have been a liona ~de resident of the State of Florida since ~ day of
, 19~'~ and I reside at `
, • t ~ tstrset.sa uiaeer;
SSd'1.~. ~~T.~~~a.~.-7~~~"'`--~-_""~~ County, Florida,
(a~r) ~
and this statement is to be taken as my declaration of citizenship, actua! legal residence and domicile in the State ~
of Florida. ~
!
,
~tnser= nae anr ~e~e~c tscu, sucn ~~e ot proPe~cr or uusi,kss. or relinquLhmeat ot empbrmeat at former ~
domicBe, remonal ot tamily to aew domic8e. purchase of dome. etc.)
. ~ 9 .
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X~'~ a~"~' 9~ - 3
~ER
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CtERR CiRCUI~ COYR~ ~ -
IlEC4R0 VERIFtE
~nt I~ ~014 ~H'~Z
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2~'7'429
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State. .
I FURTHER CERT at I have no intention to return to my former domic' , and I intend to remain in
~ .
~ , County,
Florida, permanently. ~~'t''~
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.~So/ °
(waaras) ~ ~~.c,~, •
Sworn to and subscribed before me this _1~ day of .
• .D. 19 ~:~~?:'•t.~.ausisqt~`~:',r~
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xo Pubiic State ot Florida ac Larse ' ~ : • C.; ! 3 . ~ rw,^.., ~
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My Commission expires - - ~ c~ ,
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4 .'w• ~1 z~^ ~~f . ,
(To be e:ecuted in duplicate and orisinal ftled with CktK~yiC(~N~~~upbc~ts ~h 7ax Atses~or)
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