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TU 7'll[: STA'fl: AND ('OUN1'Y 'I'AX ASSI SSnlt,
5t.Lucie
_ _ _ coun~rY, i~ i_c~~:~un:
~l~i~ is my dcdaration of Uomicilc and Citizrnxl~ip in thc State c~f Floticl,~ Ur~i ! am (ilii~t~ tliis day i~~
,~rcurcl.utcc, aml in coufortnity willi Sectic>n _'?2.l7, l~lurid.t SIc~U~irs. .
1 was forn~~r3 Ir al residcnt of ~
y ~ ~ - - - l----------- • --~~1~-~---~---- and 1
(Cily) (Slale)
residrd at ~~9 . Ho~vcvcr, I havc chan~cd my ctomicitc to
(Sttrrl ~od Numhcr)
and am and have becn a bona fidc r~~sident of the State of l~lorida sinre day o1'
; now E
- - C f' . - , 19-5 . and 1 /E4sidc at ~ _ ~ s ~S____ -
i~ . (5treet ~nd Number)
f e_~_ . St. LuCie _ County, Florida,
(c~~y)
~~nd ihis statement is to be t.iken as my dee:laration of citizenshir, actual leg.~l residenc~ and domicile in the State
of Florida.
(Inuti here any pe~linenl facis, such as salr af property or businrss, or r~lir.yuishment of employ~nent at fo~mer
dnmicile, removal uf famity to nea• domicile, purchax o! home, rtr_) ~
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Entering children in school; ~ Homestead Exemption: L!~J
2'7~491
St~lUC1E qECORDED ,
RGSE- ~~tNRAS LA.
~<<~~ ~~:~CU:T COURT
°F~^R~' ~=r'~ E4.,`..~ -
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I FURTHER CERTIFY that I will rcgister at my local address when the registration books reopen, and -
comply with all othet requirem~~~ts of a leral residcnt of'this Statc. ;
I FURTHCR CERTIFY ti~at I havc no intention to rehirn to my former domicile, and I intend to remain in `
St . Lucie Coimty, '
Florida, permanently. <<~'`y~ ~ ~ ~
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~ . . . . C~-o g e ~e-t- f3 ~A ~.e, i ~ ~
• ' (Name)
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~ ' ~ ~ ame
t , ~J ~ / e ~ '~S C x S/ 3 5
Swarri' ~.~~d.aYtbs,c~bcd be.orr n~c this day of -
~ ~0 . iTing a ress
A. U. 19~~. ~7~ /~i ~ ~P ~ ~ , 11 •
OGER POIT S,'CLERK CIRCUIT COURT
, _ ' . ~ - - a~, ~.~.,t~~ ~ot,~:-c.l-~
_ ~ eputy ~1erk
(To tx rxrcutcd in Ju~~licrlr aod ~~tq~~n.~l f~lyd .,•ith ('Icr/: f~nuit f.uurl. anJ duplicalr ~vith 7 ax A~srs~~)
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