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Declaration ~ of Domicile and Citizenship
"TQ THE STATl: ANU CUUNTY TAX ASSt~.SSOR. i~4~$s3
~S L~.~.'~ COUNTY, FLORIDA:
Ti~is is my drelaration of Uomicilc .ill(I CIII"!.l'i1S~11~~ in the Statr of Florida that ( am filing this day in
accurd:~nce, and in conionnity with Sertian "_'.17, Florida Statutrs.
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I was formerl a Ir ~al rrsident of ~.~L't!.1~ ~1`~-~1
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S~ and 1
((~11)') ($I31C)
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resi~ied at .__f~_~ i~-!~1~~ -~--LL-~- • Nowever, 1 have changed my domicile tu
(Strert and Numbrr)
;~nd am und have bren bona lidc rrsidrnt of' tlie State of Florida since ~_.~t~_ day of
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_,~,;C S 19_~~, and I rrs~cte at _ `L~tc~ ^!'t ~ C
r ~-j • ' r ` S~ L-~/ , ~Strert and IVumber) - -
- +__l U!__~~~-1 - • County. Florida,
(~'~~r)
a~~;; .~:s statement is to be taken as my declaration of ritizenship, actual legal residence and domicile in the St:~t~
ot~ Florida.
(Inseri here any prrtinrnt facls, such as s:wk of pruperty~ or businrss, ur relinyuishment oi employmrnt at formrr
domicile, remo~al of famil}• to new domicilr, purch•rsr of hnme, rtcJ
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V/iLrL^~Ci-~."'~ ~i~Yt.i
C/'C) ~ l~Q~ FILEO AND RECORDEO
ST.LUCiE COUMTY flA. CG
itOC~R P~1TRAS
CIERK CIRCUIT COURT
RECORD YER~f~ED
Il 3 v~ PM'~3
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~ 245893
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~ 1 FURTHER CERTIFY tli~t !~~~ill r<<~i>ter at m~~ locai address when the rigistration boaks rroE~rn, anel
comply with all other requiremen[s of a le~~al r~sident of this State.
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~ FURTHER CERTIFY that 1 hav~ n~~ intention to r~turn mv f'ornier domicile, and 1 intend to rtmain in
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e 0 t,cs,~~ L._- - - - . _ - • - +u-- - • -
~ F=lorida, permanently. <<~'" ~ -~~0..~i-+ci L i c~
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r ; ~ ~ '2 Inaaress?
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M ~waar~~o arftts~lbc;~i~e~ before me thi~ el.~y of
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~ L~~'~_~ - - - • A . D. 19 .
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I,',' otary`Public State of Flore L-ar~e
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" E~ty Commission cxpires _~!r_-~~ - BnOK~~U PAGE •~rW
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~ (To br r~rculed in dupl~catr enJ ur~~:inal filrJ ~~ith l'Irrk l'ircuit C~~urt, anJ Jupli: ate ~vith Tax Assecwr)
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