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Declaration of Domicile and Citiz~nshj~
-ro Tii~: STATE AI~U ('UUN7'Y TA\ ASSt~.SSOR. 26S97p
St.Lucie
_ COUNTY, I~ LORIt)A:
Tl~is is my cl~claratiun of Domicilc and Citi-r.~n,i~ip in th~ Stat~ of Florida that 1 am filin~; this ~i.iy in
accordancc, and in ronfonnity with Scrtion ~?'.17, Flori~ia Statutes.
1 was formcrly a lcgal residcnt of .5~tn .T r,~ u n , I
u~e~ o i co and 1
(CitY) (State)
resided at However, 1 have changed my domicile to
(Strert and Number)
and am and have bcen a bona fide resident of tl~e State of Florida since day o1'
~~aac~s! , 19 ~S_ and I /~rc de at -_~O/ ~i {h S~reef
(Street and Number)
For r~~e. rc e , St . Lucie County, Florida,
~ (c~~r1
and this statement is to be taken as my declaration of citizenship, ~,ctual legal residence and domicile in the State
of Florida. ~
(Insert here any prrlinent facts, such as sale of property or businrss, or relinquishment ot employment ~t former
domicile, removal ~f family to neN• domicile, purchast of home, ~tc.) .
l/~eHOea ~~eH1~H7QI'~• ~ ~GC~'II~Y f1~Q~ll rl~C)i1 -Sf_/70~/ ~ OtvlC~
~ ri t O r CG ~I P9 ~ /t f
~ ~P ~-C e ~ /c/O ~ r~ ~a .
Entering children in school; .
~
! fIlEO AN[ R~C:R0~0 '
ST.LUCIE ~~Ut1~Y FLA. 1~ `
RGCE:e : ~~TR~$ ~
~ CLEFX t.':_
E Q~~~, tUl' COURT
i 1F~ c^
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~ Ocr 15 3 23 PN '73
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~ I FURTHER CERTIFY that I will mgister at my local address H~hen the registration books reopen, and
~ comply with all other rcquirements 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
~3
~ ~ S* . Lucie
~ rOr ~~2 e , , County,
~ Florida, perniancntly. <<'~''~ R ~ N~ ~5~
~l. ~ .
(Name)
_ - ~ fi
y` :L~ f i.! c ~ S ~ sf ~
'~f ~~V15' . - - (Address)
~r S. oin~ $n J.`~1' beforc me this day of
_ ~ . ~
: {s`: l''}~ ~.n. ~ 73__. .
- ~ = ~ -
~p!~ ~AS, CLERK CIRCUIT COURT
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~ . . _ - B _ - ~c.u, R~ 2~ ~~a[~ JV5
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~~r e`p y e r
(Tu be executcd in Juplica~r rnJ ~~riti~n.d fil~ ~Ih ~'Irr~ l'ircint Cuurl.:~nJ Jupb, atr Hith 'fa~ Acscs,ot)
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