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Declaration of Domicile and Citizenship .
2'74'716 '
TO THC STATG ANU COUNTY 1'AX ASSt:SSOR, '
ST. IsUCIE _ COUNTY, E~LORIDA: '
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This is my dcclaration of llomicilc and Citizcnship in the Statc of Florida that 1 am filing this day in ~
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accordancc, and in conformity with Section ?22.17, Florida Statutes. . ~
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1 was formerly a legal resident of N~~T N SY~CpG VJ F ,/(~E tn/ y e~4 K and I ~
(CiIY) (State)
3/,3 ~ F. R S A/V7 Y E• . However, I have changed my domicile to ;
resided at *
(Street and Numbrr) d„ '
and am and have been a bona fide resideni of the State of Florida since ~ day of . '
F BR c~AR , I 9 7~, and t reside at (g~~~et and Number)
K G- ~ri! o o n ~A ~C ~S , S~ ~ v C ~ F County, Florida, '
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~~Qc N~,s F c F f~lo~r F-- So LO ~IC ~JG ~~fr N a~CrN Sy~t/jC ~~~~NJ!
(Ins~rt hete any pertinent facts, such u sale of property or business, or relinquishment of employment at tormet
domicile, removal of family to new domicile, purchase of Aome, elc.)
ENTERIrIG CHILDREN IN SCHOOL: n NOMESTEAD EX~MPTION: a ~
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If entering children in school,
please list their names:
t!,
! ~`2
"~3
HL£tt t~. f ~Cl=~D~D
ST_~iitiL :-~3~~Y Fi.A_
F?_=~ ~-?AS
CtTf:r ; :i;t: C~tSRT
f yf f .
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FEB I~I li 36 ~I'7~
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z~~~1s
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I FURTNER CERTIFY that t will register at my local address when the registration books reopen, and
comply with all other requirements ef a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ A K~ w Q e ~ PA K ST . LUC IE , County, :
Florida, permanently. (c~~r) ~ ~
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p~~ C,' oyL1 ~ ` ;
/y
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, . Grove2 C ~~JV~ E ~
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Swotn to anc~,sub;'scfit~ed before me this ~ day of
_ R o,o ~ P,o t^,, c o -r
, . = - A. D. 19~ ~
- ~ 7 9.~ R6v~v1 PA1M X~~ra Florida ~
ROGER-'PAf.IT~;~~I.E IB~LIIZ~DLII~T-
...:::•-T~. VFRa ~rhGN~ _
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By c c, Deputy Clerk ~ _
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(To ~e exec ted in Juplicale and ori~;inal t~lyd with Clerk Circuit Court, snd duplicale with Tax Asseuor) ~
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