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Deciaration of Domicile and Citizenshi
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~ro Tl~E STATL' ANU COUN"TY TAX ASSE5SOR, . 2'~4487
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ST. LUCIE _ COUNTY, FLORIDA: ~
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This is my dcclaratian of Domicilc and Citizcnsfiip in the Statc of
Flurida ihat I am filing this day in ~
~iccardance, and in confom~ity with Section 222.17, Florida Statutes. ~
I was formerly a legal resident of ~E~ d~~ , and I s~
(c~tr) (s~.ee~ ~ ;
resided at 6 3 ` E • . Nowever, 1 have changed my domicile to
(Street and Number) ~ ~
and am and have been a bona fide resident of the State of Florida since p day of
_ , 19 ~ and I reside at , ~ ~ ~p~ riti'~ Q J~ ~ ,
(Street and um6e~) '
_ ~ ~t , ~ v C ~ . County, Florida,
(~~r) •
and this statement is to be taken as my deciaration of citixenship, actual legat residence and domicilc in thc State -
of Ftorida.
(lnsett here any pe~tinent facts, such as ssle af property or business, ot relinquishment ot employment st former 'j~
domic~7e~ removal ot family to new domicile, purchase of home, ctc.)
- ~ ~ , i
ENTERING CHILDREN IN SCH04L: HOMESTEAD EXEMPTION:
If entering children in school,
please list their names: .
FlLED A?~ p~co~oFO ~ .
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% ~J~T COURT ~
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l FURTHER CERTIFY that 1 wiN register at my locai address when the regisiration books reopen, and
comply with ali other requirements of a legal resident at this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
~j ~ R~ L ST. LUCIE County,
, ,
Florida, permanently. «'`Y~ ~
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Swo~;t~~ri~/i-~s~iiti~ibed before me this ~~'Z- day o[
~~~y~~ ~ N •
~ A.D. 19.~~_.
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~~E~t . ~,p l' ~CLRK . IRS:~IT c:QUBT- , Florida
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By., ~ ~ Deputy Clerk
(To be ex tsd ln dupl~cale snd oriRinal filed wilh Cierk Circuit Coutt, snd dupiicate v~ith Tax Asuuot)
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