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-rc~ ~~~i~. sz-nT~: ANl) COUNTY Z'A\ ASSI'SSOIt, 2'~5892
SC.Lucie .
~COUNTY, 1'LOI:IUA:
'Iliis is my dcclaratiun ~f I)omicilL• an~i Citircn~hip in thc Statc of l~lorida that I ~m filing this day i~i
~ccordancc, and in conformity ~vith Srctic~n'22.17, I'lorida Statutrs.
I was formcrly a icgal resid~nt of i~! ~:v1 Y(1 and I
(c~~r) ~sa~o)
residcd at N~ 1~~~ . . Howevcr, 1 havc changed my domicilc to
~ (Strtet and t~umbet)
and am a~id ha~~c bccn a bona lidc resi~cnt of the Statc of Florida since day of
now ~
~ e~~rv~a.Z_~_____ , 19 7~ , and I/rc~idc at 3~_d ~l ,/~v,g~9N T~ (2,2 .
~ (Slreet a~d Numbcr)
~~~r t l'?~-rcP_ St. Lucie County, Ftorida,
(c~~r) '
and this statement is to be taken as my declaration of cititenship, actual tegal residence and domicile in thc State
of Florida.
(Insett•here a~y pertincnt facls, such as sale of prope~ty or business, w relinquishment of cmployment at former
domic~7e. temoral ot fa~nily to new domicilc, purchau of home, etc.)
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Entering children in school:~ Homestead Exemption: L-1
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ST.IUCtE i:~UNIY FIA, ,y`
` - RO~: . . ~:'s?AS
' CLE~ k• ~UI i COURT
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I FURTHER CERTIFY that 1 will registrr at my local address when the registration books reopen, and
comply with all other requirements of a Iegal resident of this Statc.
I FURTHER CERTlFY that I l~ave no intention to retiirn to my former domicile, and I intcnd to remain in
j~~~ j St . Lucie , County,
Florida, permanently. ~~'~y~ ~ :
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Sworn to an~~uhsccibed-~e~orc ~»r tltis day of ~
~ a U~ _
„ A.D. 19-7_4~-. ~C~.tc~ c,~ ~ '~L~ ,
ROGFR POITRAS, CLERK CTRCUIT COURT Q ~
- /-,~-e~ E~~ Florida
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(To be e:cculrJ in duplh•.~rr rnJ nni iu.il fdrJ ~~Uh ('Irrk Cin uil ('ourl. and dnplicate ~~ilh Tat Asccs~or) ~
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