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Deciaration of Domicile and Citizenship ~
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T'O THE STATE AND COUNTY TAX ASSESSOR, . .
ST. LUCIE COUNTY, FLORIDA:
This is my dcclaration of Domicilc and Citizcnship in the State of Florida that ! am filing this day in
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accordance, and in conformity with Seetion 222.17, Florida Statutes. '
1 was formerly a Iegal resident of ~v£c' C-~ E'~.~?"~' j~.P yL HNO and I
(c~tr) (sa~e>
resided at ~~/V~~~ L(,UO~~.v k'o R./~ ~~V ~f~,F'MS. However, I have changed my domicile to
(Strcet and Number)-~
and am and have been a bona fide resident of the State of Florida since ~~'ST day of
~~,~q ~,`~'~i~~ , 19~~ and 1 reside at 1C'~' ~ ~~~r~riSY~. a'~ivil~ .~i'c ,
(Street and Number)
~ J'' ~r%~~~' ~ ~ ~7` G ~'c~ E 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. •
(Insett here any pertinent facts, such as sale of ptoperty or busineu, or relinquishment of empioyment at former
domic~e, removal of family to new domiciit, purcAase of home, ctc.) s
ENTERING CHILDREN IN SCHOOL: Q HOMESTEAD EXEMPTION: ~ ~
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If entering children in school,
please list their names : 2'~':~~~c~ ~,s
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a'5~..- ~il~rC C Jle~fTY F~#,
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E I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
; comply with all other requirements of a legal resident of this State.
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~ 1 FURTNER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ~.~'T f~i~=~'~'~" ST: LUCIE
; , , County,
Ftorida, permanently. <~~~r) `
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Swoiu to~and subs¢i~b~d before me this day of n
, ~ ~ - - /~o ~ ~~v.Q. ~/~'r ~
~ A.D. 19~_. ~
.
F ROGER RK GIRSt)T~C~ 1RT ! f~E''~'C'~ . Florida ~
By ~-l•..~-~ Deputy Clerk
(To be execuled ie dupleeate anJ otiginyl filed wilh Cierk Citcuit Court, and duplicate with Tax Assessor)
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