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Decl~ratios~ ofi Dom~cil~: ar~~ Cifi~~~ns~ip
TO T11G STATI: ANU COUN7'Y "1'~~X ASSfSSOIt, 2E;8211
St.Lucie
__T_________._~~__ COUN7'Y, F1.ORIi)A:
Tliis is my dcclc~r.~tirn1 of Vomicilc anJ t'itirt•nship i~~ th~ Stat~ of Florida tltat 1,~m Cling this ~lay in
~~s~*~!a!a_~e, :!nel in conformitv with Section ?22.17, i'lorida Statutcs. • ~ ;
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1 was forn~ crly a lcgal resident of ~ c~~. w c~ and I ~
(~'~~r) (s~ste)
resided at ~1-- ~1- However, I have changed my domiciie to
~c-~ (Streel snJ Numlxr) ~ f
and am and i~ave been a bon~ fide resiclc~tt of the State of Florida since day of
now :
~CZt~ P~~D e , 19~ and 1 /~-cside at ~ L __~e~~.Cb ~ s
(Street a~id Number)
' _ _ St . Lucie County, Florida,
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and this statement is to be taken as my declar~tion ot citir.enship, actual.legai residence and domicile in the State
ot Florida.
(Insert here any pertinrnt fscts, such u salr of pr~~perty or business, ot rciinquishment of employment st former
domicile, removal of tamily to new domicilr, purchasr of home, etc.)
Entering children in school:~ Homestead Exemption: ~
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f1LED ~ND RECOR4E~ ~
• S;. LnC1E ~Od1i~ f'l„~ j
RO,En PO1TRl~S
CLfAK Cli:vUlT COIfRT
RfCOR~ vEF.~~ ;ED~~~\
~lor 13 8 sa ~N'73 -
268~11
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E I FURTHER CERTIFY that I wiii register at my local address w11en the registration books reopen, and
? comply with ali other requirements of a legal resident of this State.
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; ~ FURTHER CERTIFY that I liave no intention to return to my former domicilc, and 1 intend to remain in
E
! ' S,. • LL3C ie
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County,
~ Florida, permanently. «''Y ~
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; •~p` r; i j j•" Mamc)
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ti• • ~ - r ~~n , (AdJress)
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"9 :t e a: ~ . y : " ~
S~mi to~~n~ s,U~s~r~WF~i bc~orc mc this __I~ _ day of
° ~.4 ~~~~Qt~...,A.l). 19__Z3
i; • V • > ; ' -
~ ~"RD~EEOP,~j~~~RAS, CLERK CIRCUIT COURT
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~ o R ~2p ~A~~ 24U3
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_ - Ay L~epii~y " C~ e k`1 e-
3 (To be t?crulcd in dui,lir:~~c anJ un1au.J rd a~~lh t lrtk Cinuil C~~ucl. and Juplic•rtr Nilt? Ta~ Atu~ciut)
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