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Declaration of Domicile and Citizenship
'1'O TH1: STATG ANU COUNTI' '1'AX ASSl:SSOR,
_ ST. LUCIE COUNTY, FLORIDA: 2~~5~`~,
~ 71~is is my dcclaralion of Domicilr and Citizcn~hip in the Statc of Florida that ! am filing this day in
accordancc, and in conformity with Section 222.17. Florida Statutcs.
1 was fonnerly a lcgal resident oi ,-~~~t~--2~ , a~Y~ and 1
(c~~r) (s~.ee)
resided at ~~S ~rt f nc <<- ~ . However, 1 have changed my domicile to
(Street and Number)
and am and have been a bona fide nsidcnt of the State of Florida since day of
~~Z~~~~ , 19~ and 1 reside at ~ a~G Q~~ ~
~ . _ (Street and Numbet)
, ~ ~ ; o , ~ St . Luc ie County, Florida,
~c~~y) ~
• and thi~ statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. .
(Inseri here any pertinent facts, such u sale of property~or business, or teli~quishment ot employment at former
domicile. removsl of hmily to new domicJe, purchase of home, etc.)
ILDREN IN SCHOOL: ' HOMESTEAD EXEMPTION: ~
ENTERING CH ~
If entering children in school, ~~qo~
please list their names: -
- ~~-(~e..~..Al~ ~ ~v~.~',c-cc~-/
~ ~
/ q7O .
FtIED ~y•- `:E~~fl~EO
ST. LUC! E:4UN i Y FIA.
- ROGi r•~~jRAS ~
CLEkK :JtT COUBT
~crtl~^ ~CG ''~O
~ Ml~c ~5 1125 aH'7~
~
2'7'?'5~~2 ~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my formcr domicile, and I intend to remain in
~ G~~~~~ ST. LUCIE County,
, •
Florida, ~ermanently. cc~~r) ~
~ .1~ C/J('.,T: .
`I• r ' •I•,,, ' _Q~L/
. : . . ~ .
• - J:
~ ~ - S IGI~ATURE
_ .i ; : '
, ; .
~~~voch~tn.aud''s fi~bed before me this day of
"'{"'~G~ A.D.19 74 a~/p~ u~.~~%C~,
~ `FF i
i"I
ng~dc~'re s s
RT
IRCUIT COU
~R POITRAS CLERK
ROG . _ ~~~,,~j~~„4:ctQ/ , Florida
. .3.3~.y Z-- -
ny c c~Gtc Deputy ~lerk
v
(To be rzecuteJ in Jupli..tr and origioal t~tc.t r. ith Cletk Circuif Cuurl, ~nd JuplKale wilh Tax Axsessut)
~ aoc~ 225 oac~ 710
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