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Dectaration of Domicile and Citizenship
.
'IU THI: STA"fE AND C'OUNTY 7'AX ASSI:SSOR,
ST. LUCIE _ CpUNTY, ~LORIi)A: ~+~~~5
Tl~is is my dcclaration of Domicilc and Citizcnship in thc State of Florida that I am iiling this day in
accordancc, and in conformity with Section 2?2.17, Florida Statutes.
1 was formerly a legal resident of ~J2~1~ and 1 ~
tCtiir) . ' (sate) ~
///SSS,~~/~~~`~~- - . However, I have changed my domicile to `
residcd at ~ ~ '
(StrKt and Numbe~) ~
and am and have been a bona Gde resident of the St~te of Florida since ~L..~ day of 1
1
19~~ and 1 reside at ~~'~~l~~~'CL~ - - ~ ~
~ (Stteet and Number) f
' . - County, Florida, ~
~ ~ `
~c~~r) 1
and this statement is to be taken as my declarat~on of citizenship, actual legal residence and domicile in the State -
of Florida. -
(Inserl here anr pertinent facts, such as sale ot property or business. or relinquishment of employment at former
_ domicile. remo~•al of (amilr to new domicile, purchase ot home. etc.)
ENTERING CHILDREN IN SCNOOL: ~ HOMESTEAD EXEMPTION: _
If entering children in schooL,
please list their names:
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~~~EO ~ECa~oEa ~
fT.tUCiC ~aAS~~
RC "v~
CL~~~. :'•~i~ ~OURT
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I FURTHER CERTIFY tliat 1 will register at my local address when the registration books reopen, and
comply with all other requirements of a legat resident of this State. -
I FURTHE~L-.C£~RTIFY that I have no intention to return to my former domicile, and 1 intend to remain in ~
" ST. LUCIE ~
, t ? ,~i - - , COUIIty, .
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" F1on~~:Agl~anently. c~~~r) ~ ~
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~ ,i'1;~`.~.~~` .'~~\~`y~' X ~
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E"~%~ 0 ~ ` ~ ~ ~ day of ~
~ Swocti~tt~~nd~sld'~scribed before me this
~ - :~`~~:~(r~ ~ ~
- y~'ll?-1 , A.D. l9 74 i i ~Cd" res
ROGCR POITRAS, CI.~RK C RCUIT COURT ~ , Florida !
~
gy neputy ~Clerk ~
• 2
(To t?e eze uted in duplicole and oriKin-rl fiied ~vith Clrrk Circuil Coutt, and duplicale witl}jy~ Assessor) ,
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