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~ Dectaration of Domicit~ and Citizenship
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"I~U T~IE S'TATI: ANU COUNTY TAX ASSESSOR, ?
ST., LUCI'E ~_COUNTY, f'LORIDA: ~Zr~Q~' L,}
,
This is my declaration of Uomicilc and Citi7enship in the Statc of Florida that 1 am filing this day in '
~~c~orJance, and in conformity witli Section 222.17, Florida Statutes. ~
1 was formerly a legal resident of ~ J~~eQso~ S'~ ~-~L and I
tci~r) (s~a
r~sided at ~a R''' • . However, 1 have changed my domicile to
(Stree snd Numbet) _ ! S
day of
and am and have becn a bona fide residcnt of the State of Florida since
~ rt,t crC, ~ 19 and 1 residc at ~~00 '"1~ ST. ~..o~ larl .
_ (Stteet and Number)
F~ a7 ~j ~ e~t c e , ST County, Florida,
- tcti~r)
a«d this statement~ is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insett here sny petlinent facts, such u sale ot propertY or business, or telinquishment of employment st former
domicJe, remoral of familr to new domicile. purchase of home. e1c.) ~
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION:
If entering children in school, L-~-1 _
please list their names:
~~~JORR~ ~N ~•1 ~i uRe~ . ~
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~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with aU other rec~uirements of a legai resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain in
ST . LUCIE - County,
fo~i ~1 ~~~ee °
Florida, permancntly. ~~'`y~
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t . i . ~~t /1 E
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iJRE
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~ Sw4rn Yo~ai~d~S~~~~beforc mc this day of ~
~ . -
~ ~ _ ''r 74_'
~ ~ ~ A.D.19_
• i ing ress
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RpQ~ipk~;I S, CLERK C RCUIT COURT , Florida
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1/ O ~
~ g ~~t ~ VI eputy Clerk
Y
- (To be cxec ted in Juplicatc anJ uriRinrl Glyd wilh Cirrk ('ircuit Coutt, and duplir+lr wilh Tax Assessor) '
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