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~~c"~r~~5~~n D~~~ic~:~ ar~~ Ci~i~er~::~~iip i
f ie srn~'L' Ai~tD COUN"I~Y Tnx nsscssotr, 2'~1s62
St.Lucie `T^ COUNTY, f~LORtUA: ~
"ll~is is my dcclaration oi' l)omicilc :md Citi-r.cnsliip in thc Stat~ of Florida that 1 am filing this day in ~
a~~urclancc, :uid in conformity with Scction 222.17, Florida Statut~s. ~
.
1 was forn~
~rrly a tcga! residci~t of ~~A~,.- '
, and !
~ciiy) (S
r~sic9cd at ~~t~s~ • .}lowever, I have changed my domicile to
(Slreet and Numbe~) , ~
~~nd am and have bcen •a bona fide residcnt of the State ot` Florida siiice _ ~ day of . ~
now :
, i9 7-3 anc! I/~residc at S-Gt~ ~Pc~ ~/•tXSst~bdq~,~i~~r.e
~ ~G~ ' (Street and NumEec)
St Lucie County, Florida,
_ ~ (c~tr> ~
and ti~is statement is to be-taken as my de~laration of citizenship, actual lega! residence and domicile in the State
~t~ Florida. ~ ?
(tnsert hcte aay perlinent facts, such as sale of property or business, or relinquishme~t o[ empbYment at forma
domicile, removsl ot tamily to new domicile. purchase ot home, ete.)
`
_ ~
Entering chi2dren in school;~ Homestead Exemption: 4~! F
i
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ST, I.UC
E C4UMTY FLA.
ROGER ?OITRAS
CIERK Ci?Cltit COURT
AECCRp vfkiF~ED~.~..~,~
~AIM ~ ~ ~ Ol ~'7~
. ~
.
I FURTHER CERTIFY that I will register at my tocal address when the regisiration books teopen, and
comply with all othcr requirements af a teg~l residcnt of this State.
I FURTHER CLRTIFY that I i~ave no intention to return to my former domicile, and I intend t4 remain in
~ ,Lu~,~ St . Lucie
, County,
Florida, permanently. ~~"y~ f
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~ ; , ~ (Addreu) 4
. ~ _ 4 . ~ 33 f~S'~ ~
. , . . .
~'~o:and•~~'ribc~l befom iit~; this day of
. Cr 4`~ . _
'...,?~~t . A.D. 19_7~"
~ROGER POTT ~1S, CLERK CIRCUIT COURT
. _ . - , - . : - .l'~-.~--e.- f ~
- _ _
Deputy GT~erk
(7o he .•~acuted in Jut~lica~r and ~.ri~;inrl fii.d ~~ilh l'le~k ('ircait Court, and duplic:?tc with Tax A~sessor) .
~ ~~1:,~? PAbE~~~o
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