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t3ecl~~a~ia~ ofi Qami~ile ~nd Citiz~nsh'rp
TU Tf Il: STATI: ANU COUNTY TAX ASSI:SSOIt,
^ SC . Luc ie COUhTY, FLOR I UA: ~1934 ~
Ti~is is my dretaration of Uomicil~ a~~d Citi~cn.hip in thc Statc of Flo~ida that 1 am filing this day in
accord~~ece, and in confonnity with Scction 2?2.17, Florida Statutct.
I was fornlerly a I~g:il resident of ~ ATT~T VG~ ~ New Yur1~ a~ld 1
. (c~ir) (sa~e)
n;sidcd at ~ ~ •4v'~ • ~"O7 ~ ~O" , Howcver, 1 have changed my domicile to
(Stroet and Numbrr) '
and am and have becn a bona fidc residc~it of thc State of Florida since ~~~O~ day of
_ N o vew?ber ,~9 ~3 , and 1/re.tdc at ?OO ~~er~~a`~eS C~ l`'d • `
(Street snd iYumber)
v h~v rq e. (~o• ~ St ~a.~~E ~ . St . Lucie County, Ftorida,
~c»r)
and this statement is to be taken as my declaration of citizensiiip, actual legat r~sidence and domicile in the State i
of Florida.
(lnsert here any pertinent facts, such u sale of property or Ausiarss, or relinquishment ot employment st former
domieile. remoral oi family to new domicila, purchase ot Aome, etc.)
H ar1~ S~.ati.~ - w:~Q.P .~..nx. ~y ~3r..e.~~e~O- Ao~_ ~ w:: -
, l~t"~ r~'O'"
n~ t~^~ St~'
Entering children in school; Homestead Exemption: ~
w`^~ °~'p~l ..5~~~ «.d .e " .
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ST
IUCIE COUNTY ~
• CLE KCCIi~CUiT COURT
RECORO YE~=FtE~ ~
+~AN 1 ~0 40 ~'l~
2'~1934 ~
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; 1 FURTHER C[:RTII=Y that I~vill register at my local address when the registration boAks reopen, and
~ comply with alI other requirements of a legal resident of•this State.
~ 1 FURTHER CERTIPY that 1 havc no intention to return to my fornser domicile, and I intend to remain in
~ - ae~" q ~ St . Lucie , Connt
Y,
; Florida, permancntly. ~c~~r~
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~ ~ ~ C0~'•,~:. - (Name)
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' J i . t O ; t~, ~ (Address)
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? :~.'iy~tn.f~,~~~~'id bcforc mr tl~is day of ~ y
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3 ~'~='~~oq.'-?~~ , n.n. ? y --74- ~
; RO~R"'POITRAS, CLERK CIRCUIT COURT
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g - ao~~ 2~~?cE 157~
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` (To I.r c~ccul~•J in ul~li..~tr :~nJ uri~•~:~.~.(de ~vtl~ ~'I~•ck Circuit ('nurt. and Juplir~~c N~Ih Tax Asksv~r)
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