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Dectara~ion of Domic~{e and C~tizeEiJhip -
"t~v TfIL• STATt: ANU COUNTY TAX ASSI:SSOIt, ~ 2'~3gz9 ~
St.Lucie ___COUNTY, ~LORIDA:
Tliis is my dcclaration ,of Domicilc and Citizcnship in thc Statc of Florida that 1 ani filin~ ihis ~la~~ in ~
accurdanc~, and in conformity with Section 222.17, Florida Stahrtes. ,
! was formcrly a Irgal residcnt of ~A ~ ~ , ~ ~ _ and 1
~c~iy) (s~.i~~
nsided at -~~~k . However, I have changed my domiciie to
. (Strtet and Number) y.-~
and am and have been a bona Cdc residcnt of the State of Florida since day of `
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and 1 eside at ~
h ~ (Strtet and Number)
~ T ~1~~ C~ . St . Luc ie County, Florida, ~
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State ~ -
of' Florida. ~
(Insert here any pettinent facts, such as sale of property w business, or relinquishment of emploYment at former '
domicile, remoral of family Io new domicile, purchase of home, etc.)
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Enterin children in school:~ Homestead Exem tion: ~
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~ 1 FURTtiER CERTtC'Y that I will register at my locai address when the registration books reopen, and
~ comply with all other rcquircments of a Icgal resident of this State. i
' I FURTHER CCRTIFY that I liave no intention to return to my former dc~micile, :~nd I intend to remain in ~
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~ _ ~ St . Lucie , Coimty, ~
? 1=lorida, pcrmancntly. (~~~rl
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- . . ~ .'c?~ ~ - Signature wife ~
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- ~„~orn;taa~id siit~~t~'eci l£Qfoi`e mc this _ clay of '
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" f - A.D. 19-~~---• ~7
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Y RdG~R~~b~~°~'a~, LERK CIRCUIT COURT
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- 223 Q~E ~.380