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'TO TIfC STA'TL• ANU COUN1'Y TAX ASSGSSOIt, . - 261464
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ST. LUCTE _ (.'pUNTY; ~LORIDA: ~ ~ ~ ~
~ This is my dcclaration of Domiciic :?nd Citizcnship in thc State of Florida that 1 am filing this day in
accordancc, and in conforntity witl~ Sectian 222.17, Florida Statutcs. .
I was formcrly a lcgal reside~of xA~ ~o~~'O~~COM N- ~UEw y°2K and I
. ~c~ir) (su~~)
residcd at ~0 ,~ov r, oc' 2 . Howcvcr, I have changcd my domicilG to
~ (Street and Plumber) ~
and am and have bccn a bona Cde resident of the State of Tlorida since day of-
~A~GN , 19 and 1 residc at TiN~ SD~ivc ; ~ •
(Strett and Nun~ber)
fT• ~~~CE~ , ST. ISICIE County, Florida,
(acy)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~ -
(Insert here any perlinent facts, such u sale of property o~ busincss, or tdinqulshment o! employmcnt at tormer
domic~7q. ~emoval of family to neN• domicile. purchau ot home, etc.) ~ ~
~ . .
Applying f or homestead : . _ . . ~ . .
Entering children in school : - ~ Ch~/ca~~ -~'em G~e fb~.~
~ ~.~~xe ~a-~"~ ` - ~li~ / G 8 -
~ Other: ~ /Sou s e ~ ~
We ,Sb/aj~ o v!' -~o/~i»~ J_ Q~ ~So• ,Bo u~.oc/~
: ~St. ~ ~6~v ~i'o N ~(''o ~ i7- ~ N- - - ~ . ~ ~
i 1~ y ljus~ncaC ~~~2~u~C, f~%.~.f~u~s'hec~- h.s. ~~,,'men
~ ~a b ~ t~ S ~ . S'vpe_~ r~s a ~ ~ ~ ~ ~CC G /9 ~ . ~aH_ e.s- . i~ - i(J, y .
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. . QCER P~iTRAS
_ ~ CLERII CifiCtilt COUlIT ~ . .
• - " RECOR~ YERIFiFD. -
. ~ Auc i~ I i i4 AH ~73 . ~
. . ~ ; - . _ 2614s4 ~ .
I FURTl~CR CERTIFY that I will registcr at my local address whcn the rcgistration books reopen, and
comply with all othcr requirements of a Iegal resident of this State. ,
1 FURTHCR CERTIFY tl~at I havc no intcntion to rcturn to my former domicile, and I intend to remain in
~c,2~~ St. Lucie Count
, , Y.
~ Florida, pcrmanently. ~Fa. 6 iA nre )
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Sworn Lo~
C,. St~sF?1bte~-'6cforc mc tl~is day of
~~~'~0.,
_ A.D. 19._ 73
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RC~GER POITP.IIS, riT?P.1; CTRCUI' COi1RT gp~~17 ~1fi~i
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