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Deciaration of Dom~cile and ~iti~
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'['O TII1: STATI: AND CUUNTY TAX ASSI~SSUR, 268134
St.Lucie
COlitiTI', FLOttit)r1:
Tl~is is my drelaration of Domicile an~ Citiz~ns{~ip in th~ Statc ~f~ rlorida that 1:un iiling Ihi; ~lay i~~
accordancc, and in confonnity with Scction ?~'.17, Florida Slatutcs ~
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I was formerly a Iegal resident of O and 1
(c~~r) (sw~r)
r~sidcd at ,X~ - . Howe~~er, 1 havc chan~ed my domicil~ to
- (Strret and Numbe~)
and am and have been a bona Gde resicient of the State of Florida since ~_1~-- day of
now )
/ I/C~tl 19.~~ and I/~csidc at _ f~0 c~G u~ F'~_~_
' (Stttti and Kumber)
pi ~ ~1r.~t • , St. LuCie County, ~~lorida,
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in it~e State i
of Florida. '
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(Inseti here sny pertinent facts, such as sale ot ptoperty or businrss, or relinquishment of empluyment at A~rmer i
domicile. remova! of family to new domicile, purchase of home, etc.)
Entering children in school: Homestead Exemption: L~-~
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I FURTHER CERTIFY that I will register at my local address when the rcgistration Uooks reopen, and '
~ comply with ali other requirements of a legal resident of this State. • ;
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~ I FURTHER CERTIFY that 1 have no intention to return to my fornicr domicilc, and 1 intend to rrmain in :
~ ~ ~
St Lucie s
~2~ ~ ~~.r/~-'- , • , County, ~
~ Flor~da, permanently. cc~tr~
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~~HI~~j + 1 ~
. `u <Name
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~ , ..,~~~u,y • li,~ -
~ : _.r , ~ ~ r ~ (Address)
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~ Stii~I~~r~ -'~d.~u's~~b~cR~ct~orc'ine this----l day of -
~ ' _
~ , r ~ - A. D. 1 ~ 3_. _
. :
~ ~'0~?~~AS;'~~CLERK CIRCUIT COURT - s
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~ - 13Y ~n ~f1 c1~ _ ~OOR PAGE~~ s
~eputy ~le k ;
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~ (To bt esrtultd in duplwrlc and ori~:iu~l yd ~~id~ ~'Irr4 Citcud 1'uurl. anJ Jupli.atc ~:ith la? A~,cti•.~~r? 4
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