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~l O "171t: STATl: A1~!) C'OUh7~Y '1'AX ASSI ~Sf)It,
St.l.ucie
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This is nty d~clarati~m of Uc~micil~ :ind C'iti•r.rnsl~ip in ih~ Slatr ul~ i~loricla that 1:uu I71ink thi, clay in
:iccc~r~lancc, and in conformity wiili Scction ?'2.17, F'tc~ri~ta Slat~:t~~s.
1 w~~s forn~crty a Icgal rrsidcnt of _~~.~~„c.~Ec~_,~,_a--_---_ ----1/~,~a~_~CZ__ anc! 1
(c~~Y) (s~b~o~
r~•ti~lcd ai _~oW.v F,~ !-c'e /Q~~'`,T Bz,,~ 3_G_ Ho~~~cvcr, I ltave chan~cd my ctomicilc tc~
lStreet and Numt~tr)
:?nd am and havc bccn a bona fidc residrnt of thc St:;tc of t~lorida siizcc ~~~,L day c~t'
now
- - c ~g-- , I 9~ and 1 ~rrsidc al ~,L-----~-~O.~tY[~,~r' S L•QE ~L Vl~__. _
{Strret and Number)
__.~.er Sr. L~c~~ St. Lucie _ Co~mty, rlorida,
(c;~~~> '
a?~d this statement is to be taken as n1y declarition ot' citizcnship, ;~ctual legal residence and domicile in the St;~te
oi' Florida. _
(Insett here any p.rtinent factc, such as sale ot pruperly or busincss, or relinyui~hment of employment at former
domicile. temoval uf family to n~~v domirile, putchasr ot home, rte.)
Entering children in school:~ Homestead Exemption: i~!
2"r~SO~ .
r1~EO 4k~ RECOROEO
fT. lUC1E CO!lMTY /LA.
ROCF' r oETAAs
CLERR. ( t ~CU~Y COURT
RF~~Rf1 V!'t:td~E1 -
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I FURT~lER CERTIrY that 1~vill register at my local address ~~~hen the registration books reopen, and
comply with all other rec~uirements of a Ienal resident of this Statr.
I FURTHER CERTIFY that 1 havc no intrntion to return ta my formcr domicite, and I intend to remain in
P Q r .'Sr_ G u c.~ St . Lucie County,
f~lorida, permanendy. ~
•
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' • ~ • (Name)
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~ ame ~
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Sworrj'to.~~s~tiscribed before mc tl~is _ day of .-~Q.~ ~1( Y
~s
l~ E.~~ v.v `
~ .~~ing ad ress
~ ~
_ ~ A. I7. 19_7__4_ _/~~rr oSr• L ~ c~,~~ f~-•9 3 3~S"z
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ROGER POITRAS; CLERK CIRCUIT COURT
_ _:._.~..r:. . $ , ~c?'-~. .
y ut -Clerk - - - ~
~=-y .
(To be e+ccculcd in dupl~r.~tc and uri
~irril fi1~•d a. rth t'Irrk ('ircuit ('~,url. aad ,luplicatc ~tiitb 'rax Asxcuir)
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