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"tU'filE S'TA'I'1: ANU C'Ot?yTY T~~X ASSI'SSOit,
st.Luci_e __COUV'1'Y,F~c~t:~~~n: 2~3~O1
"Il~is is my ctcclaralion of Domicilr ancl Citizrn~hip in thc Statr c~f Plorida lhat I:~m 1ili~?~; this day in
c,cc~~nlaiuc, and in conforn~ity with Sectio~~ `_"_'.17, i~l~~rida St;~U~tcs.
1 was form~~rly a Icgal residrnt of v'~~~ and I
.
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residecl at _ . Uowcver, I h~ve cha;~gcd my domicile to
- (Slreet aud Numbrr)- "
and am and havc bc~ i~ a bona fidc residcnt of the Statc of f=lorida since ~__L~_ day ot'
YIOW .r
- ` ' - 19~
~ and I /~residc at _~~r~' ~`v ?Gi ;~f~-
' (Strcrt and NumGcr)
F Q~~ r < _ St . Lucie _ _ County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Insrri here any pertinrnt facls, such as cale of proprrtg or businecs, ot celinyuishment ot employment at formet
domicile, rrmoval of family to new Jomicilr, purchase of hume, etc.)
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Entering children in sch o.~ Homestead Exemption:
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~ 1 FURTHL'• R CER1'IFY that 1~vill rc;~istcr at my locc~l address when the registration books rcopen, and
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~ comply with all other requirements of a Iegal msideni of this State.
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~ 1 FURTHrR CERT[1=Y that 1 havc no intention ro ret~~rn to my formrr domirile, ancl 1 intend to remain iii
t ~ ~'~,r~c-~ - St . Lucie _ ~
, Count
~ FlOrida,.pern~anrntly. (c'`>~~ ~ ~
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• = . Signature (husband)~~J-
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~rv}iclttt~~8sj~~~bscribc~l b~torr mc this ~_1 ~(a~' of / / t- ~ ~ , _ -
E-~ ~zi lllg aJ( rESS
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A.i). 19_74.
ROGCR TRAS, CLE CIRCUTT COUI~T ~ _
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