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Decl~r~tion of Qomici~e and ~itiienship
!O TH1: S7'ATI: Ai~l) COUN"1'Y ~'AX ASSI:SSOR,
s t~. Luc ~e 263~'S$
_ COUN'I'Y, 1~ LORIUA:
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This is my d~clar.~tion of Domicitc and Citiicnship iii the Statc oi' rlorida that 1 am tiling this ilay in ~
a~,cordanc~, and in conCormity ~vith Section 222.17, Florida Statutcs. '
1 was formcrly a l~gal resident of ,,~~~QG~ , ~ and 1
(citr). (state) `
resided at _~~v ~°l ~S~ However, I have changed my domicile to ~
- - ' (Strect and Numbrr) ~
,uid am a~~d have bcen a bona fide resident of the State of I~torida since Q~~` 7-3 day ot ~
now . l` `
- , 19___, as~d I/~eside at -s~,-~~ r~s'ihs..~.~.~J l~~ ~
~ (Strett and NumDer)
~~c,ei St . Lucie County, Florida, '
(c~iy~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State i
of Florida. '
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(Inseri here any pe~tinent facts, such u sale oi property or business, ot relinquishment ot emploYment at former
domicile, remo~•al of famity to new domicFle, purchau of home, etc.)
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Entering children in schoc3: - ~
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fILEO AN~ RfC~RDEp
fT. ~UClE CQUMTY FI,A, -
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_ CL R[GCIRCUR-COWE~ - •
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1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a Iegal resident of thi~ State. .
3;
I FURT ER CI:RTIFY that 1 have no intention to return to my forn~er domicile, and I intend to remain in-
~.tl~.fl~ St . Lucie
, , County,
I~lorida, pcrmanently. ~c'~y~ ,
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~$:~t~,~'frri to cmcll;sii~isgribed befar. mc tl~is _ ~ay of
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"~~.'~~C •g'.~61~TRAS, CI.ERK CIRCUIT COURT ~
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