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Declaration of Domicile and Citizenship ~
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TO TNL' STAT[: ANU COUNTY TAX ASSL-:SSOR, ~ZS4a`fOO
St.Lucie COUNTY, FLORIUA:
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This is my dccla~ation of Domicil~ and Citizenship in thc Statc of Florida that 1 am filing this day in
accordance, and in conforniity with Scction ~22.17, Florida Statutes. -
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1 was form~crly. a Icg~l resident of ~1_~ r Z'1 G"e ,-~L' and I
(Ci1y) ( ate)
resided at ~Z 1~ ~ w~ ~~KL - . However, I have changed my domicile to
(Street and N ber)
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and am and have bcen a bona fide rc~sident of the State of Florida since day of
: . . _ -
_s e_~~ , 19?
3 and I~ de at a ~ y 9 S- w- /yj9~P l M G ~ R ~
~ (Street and Number)
~,Q S 7-, ~ v e(P ~o x So ~3~ St . LuCie County, Fiorida,
(~~r) .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. '
(Insert here anr pertinent facts, such u sale ot properly or busioess, or relinquishment of employment at fotmer
domicile. temoral of family to new domicilr, putchase of home, etc.)
Entering children in school:' r/~ .
- FaEO ~~r ~EC~ROF~
SL IUCtE ~uUl~tlt fLA.
ROC~~ FO~TitAS
CLERK C;.,ztl;* CCtfRT
RF~f!(rz y :r =!t ~
. S~ 1~J 10 s9 AM '73
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
compiy with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicite, and I intend to remain in
~ ~ ~T ~ T" u c ~ e ~ St . Lucie , County,
~ Florida, permanendy.
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;,.,;Y..~ - ~.~a!~L~Q ~ ~ ~tr~~n-e .
„ ~~i~~,~~~CO ~ - D - Q O (Name)
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~t to_a d,~.iebs~~i~beforc me this day of ? _
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~ .•:+t~,~~i-~r~: 73
~ ~ ~ + r~ A.D. 19-----
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~ RCSG`
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OY~TRAS, CLERK CIRCUIT COURT .
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~eputy ~~e~
~ (To be eaecWed in duptic:de anJ orytinal fi wilh Clc~k Circuit Coutt, anJ Juplicale wilh Tax Assessor)
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