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"1~U Tlti: STATt: ANU COUI~7'Y TAX ASSI:S50R,
St.Lucie
couN~rY, ~LOItIUA:
TI?is is my clrclaration of Uamicitc and Citizcnship in thc Statc of I~loricla that i am filing this day in
.:ccordancc, and in confonnity witli Scction 2.17, Tlorida Statutcs. •
I was formcrly a Icgai residrnt of , and I
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resided at Z' ~ However, I have c anged my domicile to
(Strcet and Number) .
and am and liave been a bona fide r~sident oC the Statc of ~lorida since day of s
now :
_ , 19~~, and 1 eside at
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rtet aod Number)
St . Lucie County, Florida,
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and this statemeni is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State ~
of Florida. ~
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(Insert here any prrtinent fscls, such u ssle ot property w business, w telinquishment of employment at tormer ~
domicile. removal of family to new domicile. purchasr of Aomc. etc.) ~
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Entering children in school:~ Homestead Exemption: L-J ~
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• . ` . FILEO ANO RECORpFp
. . Sj tUC~E COUNTY ftA.
. ROCfR P8ITAAS ~
CLERR CiR~~~t ~dRt
' RECORD vERrf~Ep~~
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1 FURTHER CERTIFY that I~vill rcgistcr at my local address when the registration books reopen, and
comply with all other requirements of a teDal resident of this State.
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I RTHER CERT Y that I have no intention to return to m3 fornier domicile, and I intend to rcmain in •
~ St . Lucie County,
Florida, permanently. ~ ~
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~~Iprr~ t~nd subs~bgd beforc: mc this ~ day of
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' n. n. i 3_.
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ROGE~R"~P~IITRAS, CLERK CIRCUIT COURT ' '
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(Tu bc c~ceulcJ in J~y•!i. ~~e and ~~~i~•in.d idrJ ~Ib l'Ir~/: ('itcuit ('ourl. a~iJ ~h~pG:.~tc will~ 'fa? Atitic~.r~t)
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