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Declaration of Domicile and Citizenship
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"('U T11E: STATE ANll CUUNTY TAX ASSL:SSOR, . 2~5580
_ ST. LUCIE COUNTY, FLOR11)A:
This is my decla~ati~n ot Domicile and Citizenship in the State of Florida that I am filing this day in
:~ccordance, ~nd in conformity with Section 222:17, Florida tatutes. '
1 was formcrly a legal resident of , and I
i~r) ~.ce)
resided at ~ S~ ~~~i o u- yL~ V G ~1~71~' . However, I have changed my domicile to
(Stttet and Number)
and am and have tx::.~n a bona fide residcnt of the State of Florida since day of .
~ b ~ , 19_~, and I reside at ~ 0" ~ CA-~1~. ~-J'-e '
~(}iV~f _ I~J~ , l~iGP/L-~~- ~f J . LC. G ! • ~Street and Number)
, .e ~ • County, Florida,
(citr) - .
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 facts, such as sale of pru{x~ty or business, ot reli~quishment of employment at formet
domicile, remo~al ui family to new domicite, purchase of home, etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EX~MPTION: a
If entering children in school, ~
please list their names:
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c1:.F.a r=GU~DED
gT.1,UC~i. -"3C~NTY f(,~, ~
P.4::i - :.;~g ~ ~
~ . GQURT
~'F{~•ii Yf '~E~
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' FE8 Z~ 1 k5 ~'H'~~
2'75~80
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I FURTHER CERTIFY that I wiU register at my local address when the registration books reopen, and
comply with al) other requirements ~f a legal resident of this State.
I FURTHER CERTIFY that I have no ~ntcntion to return to my tarmer domicile, and I intend to remain in
ST. LUCIE County,
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Florida, permanently. (c't''~ -
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,~,J ,.T' fJ.., ~}')'1 D ' • ~ ~
~ ~d ~ ~N ~ NG~ell~ ~
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Sw~n to~~,apd subsEribe~~efore me this day of
. , ~t
. % A. D. 19 74 . . , ~
' ~ Florida ~ ~
Rd6~~ PO~T~A~ CI.~ . GIJ.IT_COIIRT_ ~
.~~flft~~~~~~ ~ . .
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By eputy Clerk
(To be ez c ted in duplicate anJ original f~led with Clrrk Circuil Coutl, and duplicate wilh Tax As.sessot)
' E:r:~ PAGE 9~ ~
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