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Declaration of Domicile and Citizenship ,,z
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: ' 2~.~41~ ~
"1~0 THE STATE ANU COUNTY TAX ASSESSOR, ~
ST. LUCIE _ COUNTY, FLORIDA: ~
This is my dcclaration of Domicitc and Citizcnship in the Staic of Florida that I am filing this day in ~
accordance, and in conformity with Section 222.17, Florida Statutes. ~
1 was formerly a legal resident of -•~~~~n o r P Q/:2 ~ and I
(c~~r) (s~.~e~
rrsided at y~ ~a ~ k~~% `Tt ' , However, I have changed my domicile to
(Street and Numbcr) ~
and am and have been a bona fide resident of the State of Florida since ~ day of
, 19~~, and I reside at 2~~~ W. ~a V O 7? <Z Z/ ~
(Street and Number)
~ - ~ . ~ ~ , . L u ~ ~ ~ County, Florida,
(~~r3 .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicite in the State
of Florida.
(Insert Aere any pertinent facts, such as sale of property or business, or relinquishment of employmenl at former
domic~e, temovai ot family to new domicile, purchase ol home, etc.)
ENTERING CHTLDREN IN SCNOOL: ~ NOMESTEAD EXEMPTION: ~
If entering children in school, 2~,
please list their names: ~t~2~ ,
~
,
FlLEG q~: a;
_ Sj Ct1Ct~ ;OUNT
y~FIA
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R06~ .
~FEFy~-, ;.~%T C?URT . -
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~ FE8 I~ 1 07 pH ,l
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements ef a Iegal resident of this State. ;
I FURTH-ER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
j'~~ ~t , u ~ ~ ST . LUC IE , County,
-
Florida,,~ermanently. (~''r) _ • _
~ ;
•'~•.i - .
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' ` / , , - + ~ . . ,?~7 - F
• ti, 4 ~ > ~
Sw,tjrn,tb-arid-s,'~,~2i~bed before me this day of ' o -rz-f r~ b•
. _ ~ ~f'// - / L , .S~ . u C ; , C~ ~ / ~ lr.r
:G"-'~.t ~ i
Y , A.D. 19~ '
!
ROGER POITRAS# LCLERK ~jgCUIT C~URT ~t. ~ u E:'~ ~ , Florida i`
~ / ~ ~
BY ~°~`z `~-~~Deputy Clerk ~
. . ~
(To be exetuted io duplicate and original fded with Cletk Circuit Court, and duplicate with Tax Assessor) ~
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r:`:~~ 223 PAGE2,~82