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~ Declaration of Domicite and Citizenship ~
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1~0 Tllt; STATG AND CUUNZ'Y TAX ASSI~SSOR, .
_ST. LUCIC COUNTY, FLORIUA:
Tl~is is my drelaration of Domicile and Citizenship in the Stale of Florida that 1 am filing this day in
accordancc, and in conforntity with Section 222.17, Florida Statutcs. '
. . ~ ~U~-~J~ - and I
1 was formcrly a Icgal resident of ,
~c~~r) (s~.~e~
resided at ,~l.}~~ . However, I have changed my domicile to
(Slrtet and Number)
and am and have been a bona tide resident of thc State of Florida since day of
_ ~-L-~~- , 19~ and 1 reside at ~~y
~ (strect ana Numbsr)
~ ~,.~.c-t~c..(~ , a~~-~--~-~-%~ County, Fiorida,
(ci~r) -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(Insert here any pertinent (acts, sucA u sate of properly or business, or relinquishment ot employment at former
domicJe, removal oi family to new domicitr, puredase ol home, etc.) ~
ENTERING CHILDREN IN SCHOOL: Q. HOMESTEAD EXEMPTTON: ~
It entering children in school,
please list their names:
~
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~ 2'7~'793
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SL IUCi£ ; F L~~OFO
~ ..tiTr FIA.
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= I FURTHER CERTIFY that I wili register at my local address whcn the registration books reopen, and
~ compiy with ali other requirements ef a legal resident of this State. ,
~
S 1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ~~~~~c..~-~ ST. LUCIE , County, :
~ Florida; permanently. ~
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- Swq~ to~an~ s~db~Sec~~ed before me this day of ;~1
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. . ,.~'~~-~a~c ~ A.D. 19 7~.
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ROGER OITRA ~Ci.F K CIR .Cl T.OUgT- 1~~~~ ` , rlorida ~
~ gy a~ l~c.. L~o~ , Deputy C;: rk _
(To be exetuted in duplicale and oriKinal :drd with Clerk Circuit i uurl. and duplicate with Tax Assessor)
= F r:~~ 223 P~~f2825
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