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Declaration of Domicil~ and Citizenship
2'7'7Q4:3
7~O Tlll: STATI: ANU COUN'TY 7'AX ASSI:SSOR,
ST. LUCIE ____COUNTY, FLORIUA:
Tl~is is my dcr.laration of Uomicilc ancl Citizcnsl~ip in thc Statc of Florida th~t I am Cling this day in
arcanl~ncc, and in conformity witli Section 232.17, Florida Statutrs.
~A `i ~ ;
1 was ibrn~crly a lcgal residcnt ot A~ei ~ ~ - and 1
(a~r) (su~~~
rrs;ded at ~ ay /~~drre__ . Nowever, 1 have changed my domicile to ~
' (Street and Number)
a~~c1 am and havc bcen a bona fide resident of the State of I~lorida since ~ day ot
x
_ , 19~ and I reside at / g~ c~-t! Ne~o ~1 . ~
(Strect and Number) ~
_ /l/D/~~'ti An ~ ~ f ~ u c i , lGi~s ~ . D ~a County, Florida, . ,
~ (ci~ y ) ~
and tliis statement is to be taken as my declaration af citir.enship, actual legal residence and domicile in the State
of Florida.
(Insert he~e aoy {xrtinent facts, such as sale ot property or business. or telinquishment of employment at formet
domicile, removal ot tamiiy to new domecile, purchase of Aome, etc.)
ENTERING CHILDREN IN SCHOOL: ~ NOMESTEAD EXEMPTION: ~a
If entering children in school, ~ ,
please list their names: _
_
Nt~! 6~N~1 7l Ad._5 -
~/L'`j ~+/!L c~A/~'~c°S /?1//~ ~ ~
fiLEG Ati: ~.Cii~E~ Ir ;
E?. LUCIC COU~tTf fl~ C
f.7~E= r~ITRl1S
C! CAK ;~iT COUR7
Q~^,IR': l~:~rrrt!`
I~l~ J8 9 iK AN'1~
,
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; t FURTHER CERTIFY that I will register-•~t niy locai address when the registration books reopen, and
comply with alt other reyuirements of a legal resicient of this State.
` I FURTHER CERTIFY that I havc no intention to return to my former domicile, and 1 intcnd to remain in ,
~
ST. LUCIE
, County,
Florida, permancntly. ~ (c~~r)
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~ _
( I t'
.
` `.f••~`~'•'•_ •SC.• ~J~~~~ . ~ . '
14 ~~f r _ S IGI1A'1'URE
~i -f'~ . ° ~ - {i`' - ~j i
Sworn io.ati~ s~ 6~~@~`orc mc this ~ S day of - ~
, ' ~ ' }
74 l
: ' ~ ~ A.n.
~ . , . i ing re s s
ROGER PdITRAS, CLERK IRCUIT COURT Florida ~
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~
By Dep~i*_y Clerk
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(To t?e e utcd in duplicaie anJ ori'inal titcd Kith Cletk ('u ~utl, and duplicrte wilh Tax Asu'sso~)
- ~t r ~ 224 Pa~E ~992 ' :
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