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Dectaration of Domicile and itizen i ~
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TO TH[: STATE AND COUNTY TAX ASSL:SSOK, 2'7469'7
_ ST. LUCIE COUNTY, FLORIDA: ~
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This is my drelaration of Domicilc and Citizenship in the State of Florida that I am 1`iling this day in ~
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accordance, and in conformity with S~ction 222.17, Flo 'da Statutes. ' ~
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1 viras formerly a fegal resident of j~1~ and I ~
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resided at 9 ~~~'`~L'~- ~ ~ ;
. However, I have changed my domicile to ~
(Strcet and Numbet)
and am and have been a bona fide resident of the State of Florida since day of
, 19~ and I reside at ~7 ~"1 ~ {
~ , t _ (Stteet and Number) :
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T`''""' County, Florida,
(citr) -
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and this statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State ~
of Florida.
(Insert here any pertine~t tacts, such u sale ot property or business, or relinquishment of employment at former #
domicile, removal uf family to new domicile, purchase oi home, etc.) ~
ENTERING CHILDREN IN SCHOOL: Q. HOMESTEAD EXEMPTION: a ~
If entering children in school.,
ple e list th~ir n es:
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FIIEU AK~ ~ECOROED ~1~
. ST.LU:iL :.~tJNTY flA. ~
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I FURTHER CERTIF'Y that t will register at my local address when the registration books reopen, and ~
comply with a11 other requirerritnts ef a legal resident of this $tate.
I FURTHER CERTI~Y that I have no intention to return to my former domicile, and I intend to remain in
.
ST. LUCIE County, ~
F orida, permanentiy. tc'tr~ ~
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$vr(or~~tij;~d•~ubs,~a~`ed before me this day of q
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••...~~~u~ A.D.19~_.
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ROGER POITRA~a CLE~C R.»T .DI~BT__ , Florida ; ~
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$y ~ CL eputy Clerk =
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(To be execu ed in duplicate and original filyd wilh Clerk Cireuii Court, and duplicate with Tax Assessor) -
~23 PAGE~691 ~ ~
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