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- 269536
Decl~ration of Domicil~ and Citi~ens~ip
TO Ttlt: STATI: Ai~tl) COUN1'Y 'l'AX ASSl~.SSOIt,
St.Lucie
_ couN~rtr, r• ~oxiuA:
.i...~l..r..tii.» n{' Iln~i~iri~~• .~nr~ ~III%t'115~111) 111 ~~1C S~Iltl' of Florida ~~lilt ~ am filing this d'aly 111
iiJ W~~i)~ u:.~a.:a~aaaa..a I . - - i
accordancc, ancl in conformity with Section ?'?.17, Florida Statutes. _
1 was formerly a icg.~l residc:nt of _~_!~'h T~~~Y1s ~/L'ew o~. ~c and !
~c~~r) ~sa~e~
resided at ~~,~9~ f• y c s~~` ~ U~,f . However, I have changed my domicile to
(Strert and Numbetj
and am and have bcen a bona fide resiclent of the State of Florida sincc l/'-'~ ~ day of
' now
T~
~T , 19J~...,_, and !/~reside at Yo 1~ o•~~ E~ tY~~
~ (Siceet and Number)
, Sr'v,~tu«ri ~G~ nEs,, ~~a f tSf~ ~(iv G , St. Lucie County, Flarida,
(cicy)
and ti~is stai~i~~e~~t is t~ ta~~r ~s ir3 ~Ltilsr~i;GSt t?~ C!!~?:':'.S~:i~, 2Cf!!~~ IQa2I ~~Sl4.~~I1G~ ~I14~ aOiiiIC112 iii t~iC StBtC
of Florida.
(Inseri here any {+~rtinent facts, such as sate of property or business, w relinquishment of employment st tormer
domicile. removai oi tamily tu i?ew domicilr, purchase of home, etc.)
Entering children in school:~ Homestead Exemption: ~
269536
f 1f011H~ RECORD~e
S~. WCIE COUNtY FLA.
ROCER POITIU~
CL~RK CIRCWT COUA~ i~~
RECORO YEqiF1E0...~+
~bit 30 10 a3 ~i'7~
- .
I FURTf[ER CERTIFY that I~viil register at my locat address when the registration books reopen, and
compiy with all other requiremcnts of ~ leaal resideni of this State.
I FL'RTIiF•.R CERTlFY :h:~: t!:svP ne in+.~ntion to return to my farmer domicile, and I intend to remain in
;5" .~au~ s i~ L~ ~ kE T_~c~ f- ~_~f; ,G v ~ r l~F"/,~ _ St . Lucie , -
P County,
~ Florida, permancntly. ~~'~Y~ T ~ ~
~ ~
(Name)
G' 7(~ti7C2E~ ~vity r~u4~~~
.~it~Grt .
. ~ • ~ ~ . (Addtess)
.x.~'
Swqtn.Ic~raA~~-ci~~fri'~ed beforc n~e thisd" day of
~ ' _A.D. 19._ 73
~ = ~ . . -
~:;_Rt1GER POITR~I'S, CLERK CIRCUIT COURT -
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.
. ~ , ~3Y--- , - - - - B0~!c 2~~ F,1GE '
~ D~puty CI ~
(7o ix e~rn~~cJ in duplic:~lr and nr~;:~n.d f~IrJ ~+~tl~ l l.rk C~rauit ('uurl. anJ Jup6crte ~c~lb T~z Assctisur)