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D~claration of t~om~~~fe ~,s~d ~itizc~s~~~
TO THE STATL' ANU CUUN7'Y TAX ASS(~SSUR, 26~9s i~
St.Lucie
COUN1'Y, FLOEtIUA:
• r ~ f"~:•..,„~I.:.. ~n tlat. Ct•~t:. ..f Flnr~.~a 16r.t I am iilinn Iliic .1:~v in
1~1j_~ iJ jiiy~ lfi.~,~~iiaiiivii iii L'.+li~it.`.:b ~ta::a ~-i::«~..:.::~: ' V - -
accordancc, and in conforn~ity with Scction 2`_'?.17. Florid~ Statutcs.
I was formcrly a legal resident of ,~~av~- and 1
/Cr~d (City) (state)
nsided at _ • However, I have changeci my domirile to
_ (Street anJ Numbct) '
and am and h~eve bcen a bona fide residcnt of the Statc of Florida since r'd~ay of
now ~
, 19_73 , and ! /resid~ at _ ~9~/~
_~~G~~-_` ' (Street and mber
y St. Lucie Counfy, rlorida,
(C~~r) • -
ai~d this statement is to b~ taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Insrri here any prrtinent facts, such as sale oi property or businrss, ur relinquichmeot of employment at former
domicile, rrmu*•af uf f~mily to new domicile, purchase of home, rtcJ
Entering children in school:~ Homestead Exem
pt ion .
~ J~~ .
~.fo ,~~v ~~p~p~~
~ ST. LYCIE COi11iTY RA t~
ROCER POIT~tAS
_ _ CtEAX CtFCUlT 1~111tT ` .
~ lIECORO VfRtFlED ~
aec b I! i; ~i!'73
,
26996`7
I FURTHER CERTIFY _that _ I~vill register at my locat address when the registration books reopen, and
comply witf~ ali other requiremenis _~f a legal resident of this State.
I Ft;RTHER CERTl~Y t; ai 1 have ro intc;«;c;, :o r~tu.;z .c m;~ fo.^::~r d~mi~ile, ansi I inten~ to rcm?~n in ~
~t . Lucie County,
~ Florida, permanently. (c~~r) `
~ ~ ~ c~ `
' (Name)
' • ~ ' . , ' CQ,,~~'•
~ ~i7l~C~ G!~ , ~
j` 'yv~ . (A ress) .
• ~ ~ ' ` . C' ' ~ ~d. ~ ~j ~ e~
~ v
~~~tir~~to and ~nb~~r~e~ before me this day ot
t '
_t . t, -
. ~ A.n. i 73 .
~'~•~%_~~~•~d~~RAS, CI.ERK CIRCUIT COURT
.
_ - _ - ~ . . . . dOJK ~~1 +'.i+;E~ ~t.~~ ~
_By - Lt - - ~C S~1
~ e~ty~ ~ rk
(Tu be execu~eJ in duplicatr rnd ~~rigu~.~l (d.d ~ t'I~r1: ('ircuit Courl. and dupl~rale witl~ "Cra Asx•stio~)