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Deciaration of Domicile and Citizenship .
2'~485'7 ;
,
TO TNE STATC ANU COUNTY TAX ASSESSOR, . .
ST. LUCIE _ CpUNTY, ~LORIDA:
This is my decl:~ration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformiiy with Seclion 222.17, Florida Statutes. '
! was formerly a legal resident of -~7;` ~v~~~°Q- and I
(Citr) (Siste)
resided at ~GG 3" L~'~ . However, 1 have changed my domicile to
(Sueet aad Number)
r
and am and have been a bona fide resident of the State of Florida since day of
. l~l1~T
, 19~ and 1 reside at ~ ,V ~ • ~
`C ~ T` /~~l~ tandNumber)
~~et s.r~ -
a County, Florida,
(a~r) .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(laseri hcre sny perti~ent fscts, such as sale of property or business, or relinquishment ot employmeat at formet
domic0e, removal of hmily to nevv domicile, pu~chase ot home, etc.)
ENTERI:~G CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~ #
~
If entering children in school, ,
pl ase list their nam :
~ tr'~~5`7
FlLEO ANp P.ECOkDEO
` ST. WG: ~~UMTY fLA. •
ROi,i.=, ~ ~tTRAS
CLEP.K C;-CUtT C~URT
- a~rCR': ~F~~ ~:~G~~_
FE8 I~ ~Q 11 ~N'7~ ~
,
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` I FLIRTHER CERTIFY that I will register at my local address when the registration books reopen, and
i
; comply with all other requirements ef a legal resident of this State.
I FLJRTHER CER IFY thai I have no intention to return to my former domicile, and I intend to remain in ;
E ,~c..u1.~ ST . LUC IE ~ ~
~ • , , COUnty, _
` (city )
Florida, peritsariently.
f
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~t~ - ;
. .
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Sworn to a~tl:su~~c~ibed before me this ~ Y day of i~
.
A.D. l 9~4~ ~
ROGER 0 TRA , Florida
~c.~.,1v~L. ~1.~~ ~
t y ~ Deputy Clerk ~
_ ~
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(To be etecuted ie duplicate and oriRinal tiled wilh Cletk C'vcuit Coutt, and duplicate with Tsz Assessot)
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