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Declaration of Domicile and Citizenship
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7'O TtiE STATE AND COUNTY TAX ASSt:SSOR, - 2,?74;~U~I `
_ ST . LUCIE _ COUNTY, FLORIDA: ~
Tliis is my declaraiion of Domicile and Citizenship in the State of Florida tl~at 1 am filing this day in ~
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accordance, and in conforniity with Section 222. ! 7, Florida Statutes. ~
1 was formerly a legal resident of ~RT-1 ~t.. ~~t ~-~-~~~%~J`~- and I ?
(City ( ate) ~
resided at ` ' ~ . However, 1 have changed my domicile to ~
(Str and Number) ~
and am and have been a bona fide nsident of the State of Florida since ~ day of ~
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~-~t~' , 19~ and 1 reside at n C1~a
(Su t aad Number)
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~6 .~i P P~' ~ , ~ ~VL ~ P - 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
oC Florida. ~
(i~sert hete any pertineot facts, such u sale of ptoperty or Dusiness. or relinquishment of employmentat former .
domic~e. removal of family to new domicile, putchase ot home, etc.)
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ENTERING CHILDREN IN SCHOOL: ~I. HOMESTEAD EXEMPTION; ~ -
If entering children in school, t`
please list their names: . ~
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and ~
comply with all other requirements ef a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
f ST. LUCIE
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ji' f •};'r ~~~J , , County,
' Florida, permanently. (~'~r) ` ;
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Syvorin•tb ar~d~su~s~r~bad,before me ihis day of y -
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- A.D. 19_~4__. ~
' ' . t ~i ,~>>.,_~-k. , Florida
° ROGER ~ ~~~jI~RAS_ CLERK~.I T~DIIBT~
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By puty Clerk
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(To be eae ed in duplicale aod original tiled vvilh Clerk Circuit Cour1, and duplicale with Tsx Aesessor) ~
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