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t t) '1'! Il: S"fATlz Ah'l) COUN"TY '1'AX ASSI :SSOR,
St . Lucie •
~ couN~~Y, ~~~or.iun: ;~6'7462
Tl?is is my dccl;iraliun of Uomicilc and Citizcn.i~ip in Ihc St;itc c~f I~lorida th:it t am tilin~ thi: ~iay i~~
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arcur~iancc, and in confurmity iviih S~ction ~''2.17, Flori~ia Statutrs. ~ ~
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f~vas formcriy a Icgai residcnt of 0.~ ~ vVo t S _ and 1
(c~~r) , ~s~a~~)
r. sidrd at ~ ~ ~ ~ / 7.3b W•
Ho ~cvcr~ 1 h~vc changc~l my domicile to
- (St~eet and humber)
and am and havc been a bona fide resident of thc State of Florida sincc 3~ day o1'
~c~~ i now
_ , 19~~., and I/reside at 3 5/ S 13 ~ a 7~ -E~-~l.-~
(Street and Number)
_~uZ,~ -St. Lucie County, Flo~~ida,
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and this statement is to he taken as my deciaration of citizenship, aciu~l legal residence and domicile in the State
of Florida. •
(lnsert here any pertinent tacfs, such as sale of properly or business, or relinquuhment of employment at former
domicJe. removal oi family to ne~v domic~le, purchase o( hame, cte.)
Entering children in school:
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. FILED ANQ RECORDEO ' t
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CtE KCCF;CU~T C URT
RECnRn vE~~fi~fD,_„~~
Noy I 9 43 AN'13
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I FURTHER CERTIFY that I wip register at my local address whcn the registration books reopen, and
comply with all other requirements of a legal resident of this State. -
I FURTHER CERTIFY that I liave no intention to return to my fornier domicile, and I intend to remain in
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^ ~--~L4, ,~g S* . Lucie CountV s
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Florida, pcrmanently. (c~~r)
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(Address)
~ C~y,. . t;~ 1 - . . CG•, - ;
Swornc~id~in~"subscr"~~c~i;~u~ me this day of '
_ ~ ~ '-.c . ; rn : :
;~:~...;.r _ A.D. 19 ~ . , 4
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RO ~'/~t}~7~~;~'~ CLE RK C I RCU IT COUR ~ . _
- - ~ R 220 i~83
, _-_...-----~.;3:.;,_..~--~.~- !?OOK PAGE
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(Tu Me exeeutrJ in dupliratr anJ urig I(~Icd wilh ('IrrR Circuit ['uurt, anJ Juplicrla Hilh '!aa Asxc~ur)
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