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Decl~ration of Domicile and Cotiz~nshi~
"I~O'THI: S"1'AT1: ANU COUNTY 7'AX ASS[:SSUR, 269,754
St.Lucie
_ COUNTY, FLORIUA:
71~is is my dcclaration of Domicil~ and Citinnship in thc $tat~ of Florida that 1 am filing this day in ~
accordance, and in conformity with Scction 2?2.17, Florida Statt~t~~s. .
I was fornicrly a Icgal nsident of _~~«~~%~t ~ and I
r) ~ (s~ate)
resided at ~ 1 . However, I havc changed my domicile to
- (St~e nd Number)
and am and have t~en a bona tide resic~ent of the State of Florida since ----,,~~~~d~day of
now
~ ~~~_I~G~~ , 19 ~3 , ancl 1 /~eside a .Z ~D X .~SO/ - /D
-T (Stteet snd Number)
y j /~/C'C_ ~ ~ St. Lucie _ County, Florida, ~
(c~ty)
and this statement is to be taken as my declaration of citizenship, actuai iegat residence and domicile in the State
of Ftorida.
~ (inuri here any prrtinent Pacts, such as sate ot property or busiaess, or relinquishmer~t of zmploymrnt at los~tt
domicae, remov 1 of family to new domirile, purchase of home, etc.)
" ~ ~ ~
C~~2,l..GL~~~~ d~r~,~`',
Enter.ing children in school: Homestead'Exemption:~
flLE~ AliD RECWt0E0
L~ LLCiE CtTU11n ~7.~
BOC£R Pa1~RAS l
tiL£RK C~~CUt7 CO11RT
. RftORD YfR1FlfD
Oec ~f 3 0~ PM'73 y.
,
' 269'~54
E ~ -
I FURTHCR CERTIFY that I wilt registcr at my local address when the registration books reopen, and
; comply with all other requirements of a leeal resident of this State.
~
;
' I FURTHER CERTIFY that I have no intention to return to my forn~er domicile, and I intend to remain in
E St. Lucie County,
~ Florida, permancntly. (c"''~ ~ ~
. . Q '
~ (xam
i
. ~'~~`__z ,~S'v,~ 3.~ ~ d
;
s . (Address)
~ ,i. C , ~
f i P~E~~c
E
; Suir~•to and.sy~tiscribcd beforc me this day ot
~ D-~~~"'~= A.t). i 9~ 73 l' L/~ .
~ •-~~----i-r • ~
' t -
4.~-~OGL ~O~TRAS, CLERK CIRCUTT COURT
` , ~ 1
_ . . - A)! \ 1?2 ~JL = ~ 1«~~ dORK~~~ ~AGf~~ 7
~ ~ . ~
DePut~r rk
(Tu be rarcutc ' duphca~.• rnd un; r.d (dcd H~th t'Irrk Cucuit ('ourt, anJ Juplicatr with Tax Afsr~c~r)