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Declaration of DomicE~e and Cl~izenship
"f0 THE S"fATl: ANU COUN7'Y 7'AX ASSI:SSUlt, 266U93 ~
_ St.Lucie _`_~UUNTY, I~l.UR1UA:
71iis is my d~claration of Uomicilr and ('itizcnship in the Statc of I=lorida that I am rnns tn~s a:,y in
accordancc, and in conformity ~vith Scction `_'2?.17, Florida Statutrs. _
1 was formcrly a Ir~al residcnt ot'_~1~}~~1T
~ , ~C and 1
~c~~r) (s~.«~
n;sided at 3`'f . However, 1 have changed my domicile to
(Street and Numhrr)
and am and have becn a bona fide resident of thc State of Florida since i0 iS ~ 3 day of
now
_ , 19,y and I /~-csid~ at z ~ ~ ~ ~ ' ~ ~
(Street and Number)
~ T, ,a r L . St. Lucie County, Florida,
(c+~r)
and this statement is to be taken as m}~ declaration of citiz~nsl~ip, actual legal residence and domicile in the State
of Florida. ~
(Insert Aere any perlinent facts, such as sale ot property or business, or telinquishment of employment at fotmer
domicile. removal of family to new domicile, purchase of home, etc.)
Entering children in school:
~ r ~ ~ - i`t ~
/1' ~ s ~S . ~9 ~
a
' f lEA ~tli: P~~: E Lv
S~'LU~r~ r,sy~~.
IiUCE f r~J ~AS$ C .
I, GIEt~R ;;UIT ~9yRf
~ RF~°OR~ Vf?t=1rn
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A~~ 15 ID ao A~!'T3
S
zsso93
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I FURTHER CERTIFY that t will register at my local address when the registration books reopen, and
comply with all othcr requirements of a Icgal resident of this State.
~ I FUR?HER CERTIFY that t have no intention to return to my former domicile, and 1 intend to remain in
~ • ~ ~ _ ~ , L- St . Lucie County,
~ / /~l,~DA l~p j~
~ Florida, permanently. '
~ . ' ~ ~ ,
/ L <
~ ,
. (Name)
- t~~ . . ~ :;i. 5 J r~ -S~ ~ ~
~ yj`L~~ .
' C•.• ~ (AdJress)
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~s , ~ . f .`a= ~`it','~ l'~L=~c'!'~ f~
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Sw~~r(~ to and~suliscn~cd~eforc mc thi; ._J_~_. day of
~:i
~ _ ~ • - :;~~G~_ rv_, A.D. 19_ 73 . -
4: .
ROG~:~ ;PO~'~'A1~S , CLE RK C I RCU IT COU KT
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- - R { 2248
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epuY.y C~e
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(To bc rtrrulcJ in duplical~• .uul ~~nian.d I~ti~th ('Irrk t'ir._-uit Courl. anJ Jupli:alr Nith l~~ Awswr)
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