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Declaration af Domicile and Citizenship i
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TO TtIE STAT1: ANU COUNTY TAX ASSGSSOR, - 2'7439'~
_ ST. LUCIE _ COUNTY, FLORIDA: f
This is my dcclaration of Domicilc and Citizct~ship in tl~e Statc of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutcs. - ~
1 was forn~erly a legal resident of ~ x~~- ~ , ~ C~ and i
(Cilr) (st e)
resided at ~s 7~ 3~' JC ~---•~.~.z ~-t~_ . However, 1 have changed my domicile to
(Street and Number) •
and am and have becn a bona fide resident of die State oi Florida sirrce S day of
, 19~~, and 1 residc at 3~~`- ~-~'~-+-~~--C`~ ~L~.-L-~'
~ ~ ~Street and Numbcr)
PQ~L , 7~__~,~-'r-L~ County, Florida,
(nlr) •
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
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(Inurt here any pertinent facts, such u sale of property or business, or retinquishment ot employment st formet !
domicite, rcmovai of famiir to new domicile, purchsse of home, ctc.) +
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ENTERING CHILDREN IN SCHOOL: n HOMESTEAD EXEMPTIOV:
If entering children in schooZ, .
please Tist their names: t
~~~L.Y r~. L'~~iJ7Z~~ . •
~ ST. LvC;E •,~U~TY ft.~.
~1GGC~ ~GiSFUS
~L~RK C. :.'.:1T L01!$T ~
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1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements ef a lega! resident of this State. '
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
j~~.lL ST. LUCIE County,
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Florida, permanently. ` ~
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i Swor~ii+~to"~nd,s~i~5cgbe~:before me this day of ~ ~
; . r:~ ~t~ ~ = rl . ~Y ~ . ~ D J ~~~Y'~.L~Yt~i~~~.. '
~ ~ ~ A.D. 19_Z~. ~ ~
, .,;'~st,. T , _ .
RUG~. CLERK CIRCUIT ~OVB~ a , Florida
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~ By Deputy C ~ ;~k
(To be e cuted in duplicate and oriRi~al ~d with Cterk Cacuit Coutt, and duplicale v~ilh Tax Asseuor)
t:~ ~ 2~3 ~~~F~~7.
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