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~ Decla~t~n ~f D~mi~ci~e and Ci#iz~nship
~ ~ ~~os~
TO Tt1E STA ' ANU CUUNTY TAX ASSESSOR,
' ~ COUNTY, FLORIDA:
,~E~1~`' =
71iis is my dcrlaration ot Domiiile anJ Citizenship in the St~tc af Florida that l am filing this day in
accordanc~, and in conCorniity with Section ~~2.17, Florida Statutcs.
! was formerly a legal resident of ~ , ~ ' "~~~~d ~
~ ~ (citr) l tr)
nsided ~t _1~~~~~~~/f~ However, 1 have changed my domicile to
(Strtet and Kumbrr)
and am and h•e tx:en a t~ona fide rrsident of the State of Florida since ~y day of
-i~~~ 19 ~,3 and 1 residr at _~Cs~_~~ ~3G 5~5~~ _
~.^-s.~c~ - - •
(Street and NumDer)
~~~r e C, _ - County. Florida,
(Citr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inseri Aete ~ny perlinent fxts, such as sale of propert~• ot business, or relinquishment of employmeat at former
domicJe, removal ot tamily lo nev~• domicilc, purchase ot home, rtc.)
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FiLEO ANO RECG~:ufb ~ -
- ST. LUCIE COUIlTY FLA.
ROCER POITRAS ~
CIERK CIRCUIT COURT
RECQP9 VER~FIED~.~
Fee 19 !2 3o PM'~3
;
i 24805'7
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!
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I FURTHER CERT[Fl' that I will register at my to~:al address when the registration booics reopen, and
comply with al! other requirements of a leeal resident of this State.
~
~ I FURTHER ERT{FY that I have no intention to return to my forn~er domicile, and 1 intend to rema~n in
`,c.~vLC ~ t t~ount y~.
' - ~ .
Florida, permanently_ 7 «''y~~
.
-
~ ~!~Same
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tndd.~ss1
~ ~~~1dNiltill/~~~~' . /
~ Swoib~,~iq~d.Su~S9fi`djed'Gefore me this day of
~ u~ '•.y = ~
a ~
= A. t7. 19~
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~ ;/Y . _~$tate ot Florid a Larer
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~ ~~-1~4Y~or1~m i~rraac~~Yes--- - - -
~
~ - . .
~ ,(To be e~ctutPd io dupiicate anJ un~Cin~l filyd .~ith e'lerk CircuA Court, aaJ Juplicate with Taa As~essor)
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