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Declarat~on of Domicile and C~tizenship
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"TO THE STATE ANU COUNTY 1'AX ASSL.SSOR, .
ST. LUCIE _COUNTY, FLORIDA: 2~~48s .
This is my dcclaration of Donticilc and Citizenship in thc Statc of Florida that ! am filing this day in
accordancc, and in conformity with Section 222.17, Florida Statutes. ~
1 was formerly a lesa! resident of ~ k~--~~ T- and I
(cilr) . (State)
resided at 4 ~t--~ . However,-I-have changed my domicile to
(Street and Number)
and am and have bccn a bona fide r~sident of the State of Florida since day of ~
~
, I 9~~ and I reside at 3 ~ ~ ~ ~ - ~p~'~p ~ ~ ~
~ (Streel and Number)
~
~ . L~ ~ ~ ~ E `33 ~-~-52, L ~ ~ 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.
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(Insert here any pertinent facts, sucA u sais of property or business, or relinquishment of employment at former ~
domic0e. removai of famity to new domicile, purchau o! home, etc_)
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ENTERIrIG CNILDREN IN SCHOOL: HOMESTEAD EXEMPTION: ~
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If entering children in school,
please Iist their names:
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F~~EC a~,~ =Fc~~nEO _ ~
_ ST: LU.^.i ~ ~JUNTY F~A. , ~ • ~
j RCG: ~ ~~IT~AS
Ct==r. ~:Ci/1T COURT ~~~i~' 3
~ oc c •r c: c ~ c ~~....r.--i~
- FEB IZ 9 51 ~H'7~
2'~1~
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
cc~mply with all other requirements of 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
~ ST. LUCIE
' ~o s _ ~i ~---v ~ t'c , , County,
Ftorida; ernian~i'Ctly. tc''r~ . ~ ~
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Svy t~iandsu~'s~'bed before me this day of ~
~ ~ ~
~ 1CC'_ , A.D. 19 74 _
ROGER POITRA~~.~ CLERK C.IB~U~~OVBT- , Florida
By ~eputy Clerk
(To be execu in duplicate and utiFinal filyd with Clerk Circuit Courl, and duplicate wilA Tax Assessor)
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