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~riit: STA~i~~: ANI)cavtv~r>> ~i'AX ASSI:SSUIt, 26'7801 ~ `
St.Lucie ~
- ._COUN7'Y, f~LORIi)A:
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'Il~is is my dcclar,ition of Uomicilc :u~d Citiz. n,hip in thc Statc of rlorida that [ am filing this day in •
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,t;:cor~lance, and in conformity with Scrtion :'22.17, l~lori~la Statutcs. ~
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1 was fornirrly a Ir~al residcnt of 1= , and I
(City) tste) ~
rrsidcd at 'S'~ ~ ~ ~
Howcver, I have changed my domicile to
- (Sttett and Number)
aild am and have been a bona fide rrsident of the State of Florida since day of
' now • ' _
_ , 19~, and t/resicle at ~ 7~
__(Stteet a~d Number)
' St Lucie '
_ , • County, Florida,
(C~~r) . ; s
and this statement is to be taken as my declaration of citi-r.ensi~ip, actual tegal residence and domicile in the State
of I~lorida. , '
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(Insert here any pertinent facts, such 3s sale of pruperly or husiness, or rclinquishment of employment at formet f.;
domicJe, removal of family to ne~v domicila, purch:ue of homr, rtc.j ti`
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Entering children in s ool:
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l/ fT.11I~IF C~IitYf~l. ~ i
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' RECOitA v£R ~fi~g
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~ . ~t j 9 ~ ~N'73
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- - 2S'7801
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' I FURTHER CERTIFY that I wiil registcr at my loc:~l address when the registration books reopen, and
~ comply with all other requirements of a le~at resident of this State. f~
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~ URTHE CERTIFY that I have no intention to return to my former domicile, and I intend to remain in ~
_ - S* . Lucie ~
~ ~ , County,
~ Florida, perrr~anently. - i
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{ ',,i~ + ~ (Name
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~ , Sw~rn to~'d''spb~~rihcd bcfore mc this day of
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.z ,
; n.n. ~~_73 , .
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((~Ii~A•''~OITRAS, CIERK CIRCUIT COURT .
? , ~..~:.~.~~,_.:r;_..;~ ` 0 R "r~+(~1U0~7 ~i
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_ - ~eput.y Clerl- ;
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; (To bt e~ceculeJ irt Jupli.~lr anJ uti~•in.d f~~ ~~ith ('Ir~~. ('iicuil CourL and Jupli:at. with l~ax Assessor) ~ • ;
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