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'1'O "fI1G STATI: AT~~I) COUN7'Y TAX ASSI:SSOR, ~
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ST. LUCIE __(:UUN"I'1'; 1~LORIDA: ~
This is my dcclaration of Don~icilc and Citixcnshi~~ in thc Statc of l~lorid.? that 1:;u3 fling ihis d~y in
accordancc, and in conformity with Scction 222.17, l~lorida Statutcs. ~ .
/ ' and I
1 was forn~crly a lcgal res~dcnt ot
. (c~~r ' (s~~~c)
residcd at ~11~ ` ywv . Ho~vcvcr, I h:?vc changcd my domicilc to
(Slreet and 13umlur)
and am and i~ave bccn a bona fidc residcnt of tlie State of l~lorida si~~ce day of
r/~~, ~
~ / , 19-~, ~ and I reside at ~ ~ J V~'-
' (Street anJ Number)
~7I. l--~~ ~/Zi " - , ST L.UCIE - County, I7orida, .
(c+ir) '
a~id this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of rlorida. •
(Inse~1 here any pertinent facts, such u sale of properly or business, or relinquishment ot empfoyrt~c~t at [ormer
domitile~ removal of (amily to neH domicile. purchase oi home, etc.)
• ' ~ , -
Applying for homestead : . . . _ .
. ' Entering child~ in school : ~ ,.(/,~zr~ca-~
Othe r : ~ - ~ _ -
I - ~ ' FILE~ ANO RECOR~Q ~
ST. WCtE•COUNtY LA. ,
~ ~ qOGEF POItRAS - -
~ , CIER~c Cl~tCUIT COURT ~ '
- _ _ - - RECOR~ YE :'FIEO ~
_ Ru~ 1I i`l 24 PN'73
_ zszoss
I FURTI~ER CI:RTIFY tl~at 1 will register at my local address when the rcgistration books rcopen, and
comply with all othcr rcquircincnts ot a lcgal residcnt of this Statc.
I rURT1-iER CERTIFY that I havc no intcntion to rcturn to my formcr domicilc, and I intcnd to remain in
~
~3 ~o ~~L~/E ~ St. Lucie , Caunty,
~ I~lorida, pcrmancntly.
.~~~uu~i~I~ l. ~ ~
. ~ ~ ~ ~ ~ q / / ~
~ . _ 't s /
~ , a~,, ; "Y'•~('(~~v (Name)
_ .-~:i ~gOV-,,4r•jc. , ~ ~ -
. • ~ ~ f ~
~t ~G'~' . i l~. / ~ ~iI-.f~7-CZLl~.G_ '~~C~Q~" '7~-
• ; r, (Addres~j
- • . i
.-i~.'~`~ `Q . _ ~
~ I~v~1~~tto~a~,i,t~s?rl~~c~~~ed brf~r~ mc tl~is - day of
_•;,.,,~i ~ . A.D. 19__ ~
3 .
1:U'; ~ It POT'I'1:I1S, CLI:ItI: CI1tCUT'f COUI;T o Q
n.C 8C01(~1~ PACf~c3[J.
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