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~ 262001
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'CO T1tG S'TATL• ANU CC)UN'fY TAX ASSl:SSOIt, ~
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-~"°'"'--S;F. I.UCIE _ CpUNTY;1=LOltlUA: ~ ~
Tl~is is my dcclaration of Damicilc and Citizcuship in th~ Statc ot Florida th~t 1 ai~~ Gling this day in
accordance, and in conforniity with Scction 2.17. Flnrida Statutcs. .
I was formcrly a lcgal residcnt of , Q- _ and I
• ((.titr) (state)
resided at ~1~ 3- A ~ . However, I have cl}an~ed my domicile to
(Strest and Number)
and am and havc bcen a bona fidc residcnt of thc Statc of Clorida sincc day of
~ , l9_~ and 1 reside at ao / ~v r'~
(St~ert and Numtxr)
c c . ST L CIE County, Florida,
(air)
and this statement is to be taken as my declaration of citizenship, actual Iegal residence and domicile in the State
of rlorida. ~ -
(I~rt here anr pertinent lacts, such u sale ot propertr or bu~iness. or relinquishment of empiormrnt at former
domicpe. temovai ot (amily to neMr domicile, pu~cdax of home. etc.)
. • ' _
Applying for homestead : . . _ .
. ~ Entering children in scaool : ~
- . i7%~
Other: ~ - . -
- FILED ANO R COR Ep q .
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' - ROCER ?diTR~S
j ~ ~ - CLERK CIaCU1T COUIlT ( - , -
! - . RECOR~ VER!flED
[
~ - Arc 12 ~ 10 4s AN'T3 -
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I FURTIiER CERTII=Y that I will register at my local address ~ti~hen the rcgistration books reopen, and
comply with all other requirements ot a lcgal resident of this Staie.
I FURTHCR ERTIFY that I liave no intention to return to my former domicile, and I intcnd to remain in
~ ~ S t. Luc ie Count
. Y.
I~lorida, P~rnlancr~~1Y• (c~~r) ~
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Swoz`~ tqGL1~~~~`~tieforr tnc tl~is day ot
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- A.n. 19 73._.
i,OGER POI'~~~' C1.1;R1: CT1ZC _.T CnUI:T dC~~~~ PA6f~~~
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