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"I'U THt: STATl- A~U CC)UNTI' 7'AX ASSI:SSOIt, '
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St~.Lucie
263244
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'll~is iti my dcctar.lU011 O~ UOI111C1IC .Itlt~ CIl17~IlSIU(1 in thc Statc af Fiorida tliat t am fling this day in
ac~ordancc, and ii~ conlormity with Scclian ?.23. t 7, Fbrida St.~tutes. l
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1 was formcrly a 1cga1 resident of ` 'e- e~,~ _ and I
(ci~y). . (state) •
resicled at __~~lg_~~_`_A2 ~A~___~-~._ • However, 1 have changed my domicile to
~ ~ (Strect and Numtxr)
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and an~ and have b~rn . a bona fide resident of the State af florida since day of
now . .
-Q~ , 14~ and l ~reside .~t - y~ ~ Q A N A D ~
~ (Strcet and Numbcr) - - . ~ -
~ ~ £ ~ ~ St. Lucie _ Countv, Florida,
.
(c~~y)
apd this statemcnt is to be take» as my d~~laratian of citizens~~ip, acti~a! legal residence and domicile in the State
af Florida.
(Insert Aere any ~+erlinent tacts, such as sale ot property or business, or telinquishment ot employment at tormer
domicile, removal c~f family to new domicile~ purchase uf homr, etc.)
Entering children in schooZ: ~ ~
~ E 2 E ~ ~fl tJ 1 E~ IV D t"1 ~A 1~ -
ST~~UC E COUNTY FIE,A.
CLE KCCR CUIT COURT G~
R~CO~~ VE°~FIEO.,.~
$EP I~ 9 33 ~'73
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~ 263244 - ~
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i I FURTHER CERTIFY that 1 wiU register at my local address when the registration books reopen, and i
E ~omply with all other requiremeists of a legal resident of tliis State. .
~ I FURTHER CERTIFY that I have no intentio~i to return to my formcr domicile, and I intend to remain in
~
~O 21 P~ e~2 c E St . Lucie ~ Count
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Florida, permancntly. ~c'~~•~ ( ~ CNdMnN ~
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