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Dect~rat~o~ of ~om~cile and Cit~z~n~~~p
"1'O Ttil: STATI~ AND COtIN7'Y TAa ASSI:SSUR, ~
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st . Luc ie iZ69143 ~
- CUUN'I'Y, FLORIDA:
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'fl~is is my dcclaration of Domicilc and Citizcnship in ihc Stat~ of Florida that I am filing this day in ~
accordance, and in confarmity with Section 2''2.17, l~lorida Statutes. . ~
T was forn~crly a Iegal resident of .__~14A~ z-- S and 1 r
((.~~r) (s~atc) . i
nsidcd at rG ~!`~~l • Howcver, I havc changcd my domicile to ~
(Street and Number) _
and am and have becn a bona tide resident of the Staie of Ciorida since day of
now n1 ,
/~.ir~ (f , 19~y and 1/residc at ;~L.Z_ L~Z.~-~~~~ ~ l1 ~
~ (Street and Number)
~~~~~-C ~ J . St. Lucie County, Florida,
(c~~r)
ai~d thi~ statem~nt is to be taken as iny declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any prrlinent facts, such as wle of property or business, ot relinquishment of employme~t at tormer i
domicile, remova! of tamily to new domicile, purchase of home, ete.) ~
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Entering children in school: Homestead Exemption: ~
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fILEO AMD RECORpEo
i • iT.l1iC1E COUiITIr flA, .
` R06ER ~1TRAS
~ Cl.ERK CtRGUt1 COt1RT
RECOR~ VfP.lFfEO
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~ 269143 ~
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I FURTHER CERTIFY that I will rcgister at my local address ~vhen the regisiration books reopen, and ~
comply with all other requirements of a legal resident of this State. ~ `
~ I FURTHER CERTIFY that I have no intention to return to my fornier domicile, and I intend to remain in `
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~ St . Lucie y ;
~ , Count , ;
~ ~ Florida, pcrmanently. ~ ~
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' (Address)
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:~S%v,o~v'i23~and~s~5$~bcd bc(ore mc ihis ___y day of
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p ~~ir~~-~~~---, A.D. 19 ~_3 =
~ ~:`a ~-.+~~Q~ER,~T~C~TtTRAS, CLERK CIRCUIT COURT ;
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Dep" uty - Cl e ~
(7u tx execut~•d in Ju~~li.alr and uri; in.~l rJ ~~ilh ('Icrk C~rruit ('nurt. anJ Juplicale ~~i~h Tax Ac.ct.ur) ~
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