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Declaration of Domicile and Citizenship
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TO TIiC STAT~ ANU COUNTY TAX ASSI:SSOlt,
ST. LUCIE _ COUNTY, FLORIDA: 2'~468~
1~I11S iS Rl}/ (JC'claratic~n of Domicilc and Citizcnship in thc Statc of Florida that 1 am filing ihis day in
accorciancc, and in conformity witl~ Section 222.17, Florida Stattitcs. '
1 was tormerly a legal resident of
-~UGAR /IuSN ~/~/o~~S , ~h` and 1
~c~~r) ~s~~«~
resided at 39 ~~v Q•f` / v~
. However, I have chat~ged my domicile to
(Strett and Nuinbet)
and am and have been a bona fide resident of the State of Florida since 3 day of
, 19
~
2 and 1 residt at ~~~2 ~o~{~'/~1/~ l/D~ ~K?~
(Street and Numbet)
S7' ~G G~ , ~ 7` ~ U Gy County, Florida,
(ci~y) •
and this statement is to be taken as my dec{aration of citizenship, actual legal residence and domicile in the State
of Florida. .
(Insert Aere any pe~linent facts, such u sale of property or business, or relinqnishment ot employment at former
domicilo, removal ot family to aew domicilr, purchase ot home, etc.)
ENTERIt1G CHILDREN IN SCHOOL: j.~.. HOMESTEAD EX~MPTI0~1: a
If entering children in school,
please list their names:
i
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3
Fllc;,f '.c.; ~:,;~RDED ~
ST. lU~,'; ;,J~UHTY Fl~. ~(L
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FEB I~ 9 3s AN'7~1
2'7~_tibit~ r
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I FURTH~R CERT(FY fhat 1 wili register at my lvcal address when ihe registration books reopen, and
comply with all other requirements ef a 1ega1 resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
p% Si ~
v~y ~ ST. LUCIE ~ ~
County,
Florida, permanently. ~~'`y~ '
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$vi+Arn~o and su6~c,ribed before me this day of
. .
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ROGER~POITRAS+~ T LQUg~ ~ U Y , I'lorida
By ~ C ~1 eputy Clerk
(To be e~?ecute r±uplicate and ori~;inal filed wilh Clerk Circuit Court, anJ duplicate with Tax Asseuo~)
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