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Decl~r~tion of Domic~~e ar~d C~tiz~:~ship
7'O TIIC: S~'ATI: AI~u COUN'fti' TAa ASSI:SSOIt,
S~ . Luc ie 2~1~'26 - :
- - --4 _ COUNTY, f LORiL~A: ;
5
11~is is my declaration of Domicitc ancl Cilizcnship in the State of I~lorida that 1 am Clin~; this day in
accordai~cc, and in conformity with Srrtion 222.17, Floridx Statutes.
! was forn~crly a legal resident of RI.C N M 0+~1 D 1Y1 ( C 1~ l 6 A n.1 and 1
(Cylx) (statc) -
resided at _ 34'~~'~ _ R RM A D Q R~ ~ ~E R o A D However, 1 have changed my d~nticile to
(Street and Numbe~)
and am and have 8een a bona fide resident of the State of
Florida since ~ ST day of
now
AN u A 2y , 19_?~ and 1/reside at .1~SZ A DA i~ ~ D.
(Stttet and Number)
Qp2.T ST . LU~ C~ F St. Lucie County, T'lorida,
_ , `
(cicr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any pertinent facts, sucA ss sak of properly or busineu, or relinquishment of employment at formet
domicile. removal of family to new domicile, purchase of home, ete.) ~
Entering children in school:~ Homestead Exemption; ~
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KinnaEl~~Y KA~1 _ -
KEt TN ALA'`~
~p A1~0 ttEC0A0E! ~A
ST_ Li1CtE COUMTY ~lA.
. ROCER POITR~S
~ CLERK CiRCUiT COtJRT •
RECORO VER1f1E0 ~
;
J~ 3 9 33 AH'7~1 `
;
2'71`726
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` I FURTIiER CERTtrY that I will registcr at my local address when the registration books reopen, and
E comply with ati other requireme~~ts of a leba~ msident of this Statc.
~
; I FURTIiER CERTIFY ihat I have no intention to return to my former domicile, and 1 intend .to remain in
F
i PO QT S T. L U C~ r St . Lucie County,
~ ,
~ Florida, permanently. ~ (c~~r)
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