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Dec~~ration of Domicile and Citiz~nship
TO THI: STATE AND COUNTY~ 7'AX ASSI?SSOR, 264496
S~.Lucie
COUN1'Y, FLORIDA:
Ti~is is my dcclaration of Uomicilc and Citizrnship in ttie Statc of Florida tllat 1 am filing lhis d~y i~~
arcordance, and in conformity with Section 2?2. ! 7, Florida Statutrs.
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I was formerly a legal resident of , and 1
(c~~Y) _ (sa~e)
resided at a3 ~3y'c~~ . However, I have changed my domicite to
(Sttett and (Yumber) ..~t~
and am and have been a bana fide residcnt of the State of Ftorida since ~~'t/~t day of
~ now G ~
, 19 and 1/~esidc at O 9~ S,VI,/.
\ (Street and Number)
. St . Luc ie County, Florida, +
(ci~r)
and this statement is to be taken as my declaration of citizenship, actual iegal residence and domicile in the State
of Florida. - - {
(Inseri here any pcrtinent facts, such u wle of property or business, or relinquishment of employmeni st former
domicile. removal of family to new domicile, purchase of home, etc.)
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Entering chil.dren in school: •
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fILEG Ah~ REC~ R
ST. CUC~E C ~UM~~ ~t
kGCEr F! iRAS
CLEi~ Cisc~~3T CQ~q~
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264496
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I 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 this State. ' f
I FURTIiER CERTtFY that 1 11ave no iniention to retarn to my former domicile, and 1 intend to remain in ~
: ~ St . Lucie '
, County, ~
Floriti~~ ~~h~nently. tc~ty~ ~
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~•f•~•ti. v ~ ~Address)
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S~B~tc~,cTci~'~scriEcd b~fore mc this;,~__~ day of ~
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f~L_---~., A. D. 19.,7 3
ROGER POITRAS, CLERK CIRCUIT COURT
, . - - - -
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_ ~ - - gooK 2~9 PA~ 133
Deputy- Cle
(To be execWeJ in Jupli~alr aoJ ori~•m.d d with ('Irtk ('inuit ('uurl. ~nd duplicatr ~+~~Ih iaa Acsecu~r)