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. 27~668
7'O Tt1G STATf: ANU COUNTY 'i'AX tISSE:SSOtt,
~ St .Lucie _ COUNTY, FLORIDA: ~
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Tl~is is my dcclaration of Domirilc and Citizcitship in tl~e Statc of f~lorida that t am Cling this day in
accordari~c, and in conforn~ity with Scction 2?2.17, Florida Statutcs.
1 was formerly a legal resident of l~i~ ~7~''~d ~ and~ I
l (cilr)~ (state)
resided at l~i?~~~1~'SlWQ ~Q~C.e . However, I have changed m domicile to
(Street and Numper) ~ ~ ~
and am and have been a bona fide resident of the Statg,~C Florida since day of
C~~~P~- ~r
, 19~y and 1/Es icie at ~ 9~~~~~'.d.Q7t,.
f
)~~G / j _ (Street and Num6erj ;
? ~ S t. Luc ie County, Florida, ~
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(~~r)
and this statement is to be taken as my declaration of citizenship, actuat legai residence and domicile in the State
of Ftorida. ~ ~ .
(Inxrt Aere anr pertirte~t lacts. such as sale of property or business, or «linquishment ot employment at tormet
domicile. removal of family to new domicJe, purchase of home. etc.) ~
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Entering childr~n in school:~ Homestead Exemption: 1,Ar1
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F1lED AN~ RECOROEO . ;
ST. LUCIE_GOUlITY FlA- ~
ROGFn Ft~11ilAS -
~~~RK C:.~~UIT COURT
, RECQR4 YEK~f 1Efl.~r ~
,1~ Z 1 43 PH'i~
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I FURTHER CERTIFY that I~vill register at my loca! address when the registration books reopen, and
' comply with all other rec~uinments of a legal resident of tliis State.
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I FURTHER CERTIFY that I havc no intention to rcturn to my former domicile, and I intend to remain in
~O~-C G•-l,cC~p St. Lucie
, , County,
Florida, permanent~y: cc'~Y~
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% A'~ -i.~:~ jsc'~'.,+- ~ (Addtess) f.
~ ~ $ .
3iort~or~i~~ nc~;su~$ed before me this day of ~
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A.D. 19__Z4_.
ER POIT S, CLERK CIRCUIT COURT
. ; ,
. . - .
- --uty ~Ie rk~ ~ .
(Tu bc executrJ in dupli:a~r and urigin~l fi1~•d with ('frrie Circuit Coutl, anJ Juplicate with Tax Assesso~)
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