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. Decl~~r~~ti~n ot Dornicile ~i:ci Citizc.•nst~ip
1 U T 11E STA1 E: AND COUNTY TAX ASSCSSOR,
51. lUC1E ~OUNtY, fLORIOA:
This is my decla~ation of Oomicile and Citizenship in the State of Florida that 1 am filing this day in atoordarxe a~d
~n confo~mily with thapte~ 222, Scction 222.17, Florida Statutes.
ornnerl a le al ~esident of . i i~ ~~%~-~L~
1 w a s f y g
(State)
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a nd 1 ~esided at U°~ ~ . Nowever 1 have chanc~ed my domicile
• (Street and Number) ~ ~
to and am a~d have been a bo~a fide resident of the State of florida si~ce ~ ~Y ~
` % O ~e
_ ~ , 19~, and I reside 'at ~ '
_ (Street a~d Numbe~)
FOR? PIERCE, SAINT LUCIE COUNTY, FLORIDA -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any peNinent fads~ such as sale of property or business, or relinquishment of employment
at fomner domicile, removat of family to new domicile, purchase of home, etc.)
Applying~ for Homestead -
- Entering children in school : v iu~
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lL~ti Ct~l~ q~T
_ ~ REC4R01?fRsf1~~
~.~.,Gu.a-- ~ Ant ~ !i-sY ~ 73
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1 FURTHER CERTIFY that I will comply with all other requiremenis of a legal res~dent of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domitile, and I intend to remain in fORT
~ et~~ /'?~1 - GreeR -
PIERCE, SAINT LUCIE CO.UNTY, FLORIDA, permanently. ~ ( -
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- ~ (Name)
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~~~~cribed before me this ~ day of _ 19
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ROOER POITRAS
CLERK CIRCUIT COURT Notary Public
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py _ O.C. My Commission expires
a~212 ~~~20 -
(To be oxeculod an duplicate a~d c ;~~al filed with Clerlc Cirwit Court, and duplicaf~ witb Tax AssessorJ
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