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Declaration of Domicile- and Citizenship
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2'~4643 ~
TO THE STATE AND COUNTY TAX ASSESSOR, . .
ST. LUCIE COUNTY, FLORtDA:
This is my declaration of Domicilc and Citizcnship in ihe State of Florida that 1 am filing this day in
,
accordance, and in conformiiy with Section 222.1 T, Florida Statutcs. ~
1 was formerly a legal resident of ~oC/fr~~~~C , f1~~^~f~N~ and I
~ (c~~r) ~aie)
resided at ~ y~ - . However, 1 have changed my domicile to .
(S:ree snd Number)
and am and have been a bona fide resident of the Siate of Florida since day of
~,`~>~e , 192~ and I reside at ~ ~ ~/t~~~/ G`E
~
~ (Street and Numbet)
~ i,~ , L / ~f~'C ~l~ County, Florida,
(c;~y) .
and this statement is to be taken as my declaration of citizenship, actual Iegal residence and domicile in the State
of Florida.
- . .
(It~.sert here any pcrtinent facts. such u sale of property or business, or retinquishment of ~mployment at tormer
domicile, removal of family to new domicile, purchase of home, etc.)
ENTERING CHILDREN IN SCHOOL: n. HOMESTEAD EX~MPTION: ~
If entering children in school,
please list their names:
~
' FiLED a4=: ~ECGfi0E0 .u~~ . .
~ ST. LI;C;£ .,~JMT3' FLA.
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P~c~.- • . CJURT ~
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FE8 13 1 OQ ~M'7~
~ 2'~46~3
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~ I FURTHER CERTIFY that I will register at my locat address when the registration books reopen, and
~ comply with all other requirements of a legal residerit of this State. ~
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~ I FURTHER CERTIFY ihai I have no intention to return to my former domicile, and I intend to remain in
~ ' ST. LUCIE ~
} / p~n~ ~S~ L G C~ , , County, `
' Florida, permanently. ' ~
_ i~~~~ C-~
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4 ,.,`~~~~~.~~t~~~I,,i
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- SwoFti.,;Q.'~nd~sut~s~ibed before me this day of , ~
= ~
: y~' y v~'
~i ~~/l ~/v~~r
- . , A.D. 19~~. ~
- , a';SSI- ,
s~ ~ ~p ~7RCt1TT .o ~R~ ~ ~C ~ ~ ~ Florida
_ .~35~.~~ -
~ By' ~ Deputy Clerk
. .
(To be executed in duplicate anJ original filyd with Clerk Cucuit Court, and duplicate vpth Tsx Asscssor)
• t r ~ 223 PAGE~?U~S
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