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Deciaration of Domicile and Citizenship ~
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`~'U THti STATE ANI) COUNTY TAX ASSL•SSOR, . ~
_ ST. LUCIE _COUNTY, FLORIDA:
'iliis is my drelaration of Domicile and Citizenship in tlte State of Florida that 1 am filing this d~y in
aceordance, and in confarmity with Section 222. l7, Florid~e Statuies. '
I was formerly a legal resident of ,_-l ~ni S and 1
(citr) (state)
resided at y~~ N~.r l~i9s/,'.r/~~D~ . However, I have changed my domicile to
(Slreet and umbe?) ~
and am and have been a bona fide resident of the State of Ftorida since ~6' day of ~
s
i
, 19~y and l reside at L~
a'A~ C~y~`T ~
` ~ (Stteet and Number) t
~r,1 /fi.~f~.c , ~i . ~ ~~c ~"a County, Florida, ~
(c~tr) .
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and this statement is to be taken as my declaration of citizenship, actual lega! residence and domicile in the State ?
of Florida.
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(laurt here any pertinent facts, such as sale of property or business, or telinquithment of employment at formcr
domicJe, removal ot family to new domicile, purchase ot home, ete.)
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ENTERING CHILDREN IN SCHOOL: 3 HOMESTEAD E7{~MPTION: ~ ~
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If entering children in school,
please list their names:
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f~~EQ A'+ - ?EG~~;DEO
/ ST. tU"~= :.OCN7r FtA.
7d ~.1~ l/G /7/~ RG~i ' ~~T~AS
Ct~F! ~ , COURT ,
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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 of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to rcturn to my former. domicile, and I intend to remain in ~
`'~e rT ~ ST . LUCIE , County, :
f
Flor~d~;'p~'ri~tast~rttly. cc"r)
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,y~ I T~' _ V~irC e nrT L. atM/j~9NAi?
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Swom ta ~~nd '~~bscribed before me this day of ~ ;
, ~.c.~u /,C",Y~9S Cd tii-/ s
A.D.19_Z~_. ' '
ROGER AS., CLERK CIR~UIT CQI1g~ ~'d~~/~,~~~•C , Florida ~
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By C-~ti%~'~ Deputy Clerk
(To bs execuleV in duplicate and original filyd wilh Clt~k Citcuit Courl, and duplicate with Tas Assessor)
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rC y i ~ttE 25a5