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Decl~c~~~~~a~a ~fi ~~rn~ ;~4~ ~r~d Citizenship ~
"I~O Ttlt: STAT{: Anl) COUN'i~l' '1'~~X ASSi:SSOIt,
S~ .l.ucie '
CUUN'TY, l~ LORIUA:
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This is my ctrclaratioi~ of Domicilc and C'itizcnship in thc Statc of Florida that I am filing this day in 3
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accordancc, and in ronf~rmit~~ with Srrtion 23_'.17, f~lori~la Stalulrs. i
1 was fornmrly a Icgal resid~nt of _~l~i rDuJ _ , N,~• and I ~
(c~~r) (sace) !
resided at io? ~~~~e~__L~~~ . However, 1 have changed my domicile to ~
(Strrrt and Numt+cr)
and am and havc bcrn a bona t7~c resident of the State of Florida since ~~~~G~`S~~~ay of i
now - ~
, 19_ , and 1~residc at /V- ST
(Strcet and Number) ~
~ St. Lucie County, Florida, ~
(c~tr) - - :
and this stat~ment is to be takcn as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(Iniert herr any pertinent facts, such as salr oi properly o~ Ausinru, w relinquishment of employment at former
domicile, removal of family to new dumicile, purch•rse of home, cte.)
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Entering children in school: ;
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~ I FURTHER CERTIFY that 1~vill register at my local address when the registration books reopen, and
~ comply with all other requirements of a legal resident of this State.
~
~ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ^
~ s`-~~~ ~~ce~ e,~, _ , S''.. Lucie , Co~mty,
~ Florida, permanently.
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Swprn tp, ~p~~~~fxforc mc thi. day of
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~ A.D. I~)---73 - :
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(Tu hc cAeculcJ ~n Ju~~fical: .~~~~I ~.n~ t~.~l idcd ~citb l'Irrk t'ircud ('~~wl. anJ Juplr• ~tc N71I1 T:1X Asxssor)
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