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Dectaration of Qomici4e and Ci~izer~~hip
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TO THE STATE ANU CUUNTY 1'A~C ASSCSSOR,
269118
St.Lucie ~OUNTY, FLURIDA:
Tl~is is my ~lecl:~ration of Domi4ilc and Cilizcnship in thc Statc of Florida that ! am filing ihis ciay in
accordancc, and in conformity with Section 222.17, Florida Statutrs.
I was formcrly a Icgal residc•nt ot' _ o o e S fi o~ , L. and I
3 30 G~/~ t ~ ; ~.o '~r) (sa~~~
resided at ,o ~ ~ J . However, I have changed my domicilc to j
_ _ , Strset ~nd Numt~rr) }
4
and am and have bec~i a bona fidc resident of the State of Florida since Lyv ~l ~a3y of }
now f
_ , 19~3 and 1 /j-csidc at -_,I/ 3 L~ ~ _ ;
" (Streel and Number)
~7'": ~O
f Q R c~~ _ . St . Lucie County, Fiorida,
(c~~y)
- and this statement is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State
of Florida. .
(Inserl here sny perlinent facts, such u sale of properly or Dusiness, or relinquuhment ot employment at former
domicJe. removal of family to new domicilc, purchsse ot home, rtc.)
Entering children in school:~ . Hamestead Exemption: ~
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' ' fILEO AND REC~R ~p. -
; ~ =T l C1E COUN7'1? ~
~ CIEkKCC RCUIT CO ~ ' ~
~ RECOa~~ vEc~FlEO {IR
~ ~6 9 AN 'T3
~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State. ;
~ I FURTHER CCRTIFY that I have no intention to rcturn to my former domicile, and I intend to remain in
,~,2~ ,Q_ St . Lucie Count '
, Yf - i
Flonda permanently. (c~tr) ~ ~ ;
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~ pdame)
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# • . (Address)
(i ` ~ t •y ~w ~ir- :
~S S~vciNi•t4nnet~~~/`~?eforc me this day of i
:7 ' ` _ ! n • % i
_ . • '~{,~'i t.- 7 3
~ _~~Ef•i~ ~ ~ ~ ~ A.D. i 9__ . #
~ ~~4 CLERK CIRCUIT COURT t
~ . ~i ;~..s~.':lJr ` - DVQx~+ri~/i f~Yl. V~~
~ ~ ''t'~:''-~=t~- • _ ~3~ ~l'~, . rn~ -
~ ' ~ ~ ' eput}• Cl-er
e- (Tabc carcultd in Juplir•rlr .~nd ~~ri4ina{ t~l~ isilh ('Ici~. l'ittuil Cuurl.:u~d Jupli::~lc ~v~lh Taa Acs~sstx)
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