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~CO Tllli STATE Al~!D COUNTY TA\ ASSI•:SSOR, ~r~a3093
St .Lucie _ COUNTY, ~LORIUA:
Ti~is is my dcclaraiion of Domicilc ,ind ~'itizenshi~~ in tt~~ Stale af I~lorid:! that 1 am lilin~ thi. d~y in
ac~ordanre, and in conformity with S~rtion'?'.17, Florida Statut~s.
1 was formerly a legal resident of _ ~Q'vvV and l
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rrsidcd at ~6 ~~?~22i.1 ~1I~__ . Howcvcr, 1 ha~c chan~;ccl my domicile to ~
(Street and Number)
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and am and have becn a bona fide residrnt of the State of Florida since ~ Q _ day of
now • _
. u41n~_ , 19~ and l /~-eside at ~v O (o S , Y . I7~~4~~ ~2~ V ~
(Street snd N~~ii~brr)
~ ~ ~ ~ ~ . St . Lucie County, Florida,
(c~~y)
:~~~d this statement is to be taken as my deciaration of citizenship, actual legal residence and domicile in the State :
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Uf Florida. + ~
(In.ceti hete sny pertinrnt facts, such as sale uf property or busines~, or relinquishment ot employment at fo~mer
domicile, removat of family to ne~v domicile, purchase of home, ete.)
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Entering children in school: ~ Homestead Exemption: i
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~ I FURT}iElt CERTII~Y that 1~+•ill rcgistrr at my local address ~vhrn the registration books reopcn, and
~ comply with aU other mquirements of a legal resident of tltis Statc.
` I FURTHL=R CERTIl=Y that 1 h~ivc no intrntion to rcturn to my fornicr domicilc, and 1 intcnd to rcmain in
Luc ie
S ~ G ~ St ' , County,
--~~0 2T T~ , -
r~; rlorida, rrrmanently.
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Si na~ure (husband)
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S nature {~vi£e
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L, ! • ...,r ~ t /~Sr, c._.G-~•-~
Swori~ tq'.~}sut~~vri~cd befc~rr mc thi. __Y3 _ ~ay of J
, ~i-aiTi»~c3ress
5 3~ ~F ~ - - . n. r~. i ~ _74
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_ •1~DC~~t PO~rRASa C1.ERK CIKCUIT COURT . _
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