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l~c~l~r~z~~i~ af ~or~~c~~~ G:~?d ~~~i~.~:e ~~~~~3
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'l~U Tl lf S7'ATG AND COUN7'Y TAX ASSI:SSOR,
_ st.Luc~~ couN~rY, r~ok~un: ~ ~0i53
Tl~is is my dcclaratia~ of Damiciic and Citizc:nship iit thc Slatc ~~r r-~Q~;~a tl~at 1 am filing this day in
accordancc, and in canformity ~vith Scction 222.17, l~lorida St tutcs. • . .
~ ' L~-~~ - and 1
1 was fonncrly a lcba! residcnt of ,
r--- (ci~y (se.ir~
residcd at ~ . Howevcr, I havc changcd my domicile to
(Strcet an Number)
and am and h e been a bona fide rrsi~l~nt of the State of Florida since ~ , day of
~ now
~ , 19~y and 1 /~cside at
_ (Street and Number) j
' ~ ~~r - , St. LuCi County, Florida,
` (c~~y) ~
_ and this statement is to be takcn as my declaration of citizenship, actual legal residence and domicile in the State ~
of Florida. .
(Insert here any perlineot facts, such u sale of pcoperty or business. or telinquishment ot cmployment at former
domiCOe, temoval of family to ne~v domicJe. purcAase of home. etc,) }
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Entering children in school:~ Homestead Exemption: ~
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- ' ~ FfLEO AMO RFCaRQfO
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. ROCER F'OITMS `
' CIERIf C:RCOti COtIRT ,~-4
- _ • ~ RECORD v~R~f1E~~~..~.I
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I FURTHER CERTIFY that I~vil! register at my local address when the registration books reopen, and •
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€ camply with all otlier requirements of a legal resident o~ this State. ~
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= I FURTHER CERTIFY that I havc no intention to return to my forn~er domicite, and I intend to remain in s
~ ~
~ ~ -~,c ~~ti ~ St- . Lucie , _ County, ~
; ~ Florida, permanently. r ~ .
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; j • • (Address) •
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~ Swo~1~ t2~ arid~ifi~c~i~d,bcfore me this ~ day of ~
; r: : i-" . G , i
_ _ ~a-, ' ~r, A.D. 19 73 _ .
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n • 3 ' ° . - ' ~
~:-'•R~ER~PO~S~N~~ CLERK CIRCUIT. COURT '
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z ~ , . ~c'~'~ - $o~k22~~ ~~~-2003 ~
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(1'u be ezeeulyd in dupfica~r :u~J uti~•m.~ drd ~v~{h l'Irr1. Citcuit l'ourl. rnd Ju~e!~cate ailh Tat Acec~tioti ~
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