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De~~~r~~:~n ~5~i ~~:~~~ic~~~~; ar~~1 C~~izer~~hip
'1~U "fHl: ST~~'fG ANU COUNTY 7'AX ASSGSSOIt,
_ st . Luc ie i_ CoU~TY, r• ~oR~un: 2'716S'7
Tliis is my dc~;laratiun of Uomicilc anci Citi•r.cnsiiip in thc St.~tc of Florida that 1 am filing this ~ay in ~
accordance, and in conformity with Srctiun 222,17, Florida Statutes. '
~
I w~s fonncrly a I~~gal resident of - r~~. ( p 1~? ~1 1"Q o and I ~
(City) ' (state)
resided at ~ . However, I have changed my domicile to
_ (Street and Number)
and am and have been a bona ficle resident of thc ~ State of Florida since day of
now ~ ~y( l va. Cif -
, 19 7~, and I/Ecside at '
(Stteet and Numbet)
~ r..}. ~ u c~~ , S t. Luc ie County, Florida,
. (c~~y)
and this statement is to be taken as my declaratiori of citizenship, actual legal residence and domicile in the State
of Florida. , '
(I~seri here any perlinent facts. such as sale of property or business. or relinquishme~t of employmeat st tor~ner
domitile, removal of family to new domicile, purchase ot home. ett.)
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Entering children in school: Homestead Exem tion: ~
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~ I FURTHER CERTIFY that I~vilE registcr at my local address when the registration books reopen, and
~ comply with all other requiremei~ts of a leaal resident of this State.
~
~ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ p r-}' : ~ U c~ C St . Lucie , County,
,
~ Florida; perntal~ntly. (c~~r~ 3'o i c e~
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' O~, .•~j~j ~ . . (Name)
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- i~•-.'~ '~~~•i'j.. ~AddfCSS~
N ~ ~ 'y ~ : P.I~,t~~'~: ~,r- ~rat.
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ed brf~~rr mc this ~lay of
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~ • ~ - - - • i . D. 19_7!~. ~
ROGER POITRAS, CL~RK CI:CUIT COURT
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~ Depur_y Cler
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N (To M1c rxcculed in Juplical~ :~rd ~~ri~~i~utl filyd lh ('lr~A t'ircuit CrnuL:~nJ duplpale wilh Tat Asscswr) .
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