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Declaration of Domicile and Citizenship
7'U THf~ STATE AND COUNTY TAX ASSl-:SSOR. 24,~~54
. ~ c i ~ _ _ ('OUNTY, FLORIDA:
Ti~i~ is my d~itaration ot~ Uonticilr and Citi7.et1s111p i~~ the St~?tr c~f florida thnt 1 am filing this day in
ac~~nl~ncr, and in contorntity with Sertion i 7, Florid~i Statutrs.
I was Cormrrly a le ~a! residrnt of ~
i. L LG~ ~s._Y - - - and 1
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a•~~y ? (swcr~
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r~sided at L~ ~l~' 1.~_~- ~'~?~Q------- How~v~r. I h:~vc changed my domicile to
(Slrrrt and Numtxt)
and am and have bc~n a bona tidr rrsidrnt ot' the State oi~ Florida since~ day of
~ :
~ .~Z'~t- _ _ . 19_7,1_. aiid 1 residr at 7"C~~.~.L'.~~ <-~'~5~~ -1'------------------
~ . ~ (Strrrt and Number)
~L ~i ,,C
---'s-='~-'--!_ -~-~-t - - . ~~i Coimly. Florida,
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,
:~nd this statement is to he takrn as m~~ dcrlaration of citizenship, artual legal residence and domicile in the State
of Florida.
(In~r~i herr any prrtinrnt facts, wch zs sale ot pruprrty ur Ausinrss, u~ rclinyuisAmeM ot rmployment at fotmr~
dumicilr, removal oi familY to nr« domirile, purchasr of hnmr, rtc.)
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FI~EO Aw0 REC4RDED
ST: LUCIE GOUMTY fU. .j
ROCER POtTttA$ ~"r
CEERK C~nCU1T COURT !
AEf.ORD Vf
~~FiEp ~
FEe 1 4 oi PN'T3 ;
24'71.54
1 FURTHER CERTIFY that t will rc~istcr at my local acldress w1?en the re~istratioi~ books rropen, and
~omply with ali other rcquir~nt~n[s of a Ic,*~1 resid~nt of this Statr_
I F RTNER CERTIFY that 1 ha~•~ nc~ intention to return t my forn~er omirile, and I intend to remain in
;
' ~ ~ [ _ _ _ _ . _ - - _ _ _ _ _ ' - _ _ -(~-t-
_ . County.
Florida, permanenUy
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~~ott~ i,o~~~a y1~s-ibed b~fore me this . day of
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,P " . A. D_ 19
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- ary 1'ublic State ot { IunJa at e
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My Commission expires _ _ _ (f~' ~ ~
_
(Tu be e~rcutrd in dup6ca~e and unFin.il (ilyd ~+i1h ('lerk ('~rcuit C~wrt, and duplir~te with Tax Assessnr) !
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