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Dectaration of Domicile and ~itizenship
1'O TUt: STATt: AND CUUN7'Y 7'AX ASSk.SSOR, 2~S
`ST. LUCIE _ _ CpUhTY, FLOR11)A:
This is my dcclaration of Domicile and Ciiizcnship in thc Statc of Florida ihat [ am fiting this day in
accordancc, and in conformity witl~ Section 222.17, Florida Stat~~tcs.
I was formcrly a lcgal n~sident of and I
. ~.`.r (ci~r) (state)
residcd at BrAC~~rr,~ f~// ~c~ . However, 1 have changed my domicile to
(Sueet and Number)
and am and have bcen a bona fide residcnt of the State oP Florida since ~y ~ day of
.
~B r~~ , 19_Z~y and I reside at ~s~~d S a?a? S~
. (Street and Numbe~)
,f'o rT . ~ St . Lucie County, Florida,
~c~iy~ i
and this statement is to be taken as my declaration ot citizenship, actual legal residence and domicile in the State }
of Florida. ~e!'T w~er.E .AT coN~• ~~AO~~~ ~~Y 6NT/K~ F~~,~~cj ro fo~r r,~.~r
~~vo[~d.,,i' .wor/~~.-r is~T.lc~- -..~r - li?w-
(lnsert hete any pertinent facts, such ss sate of propetty or business, or relinquisMment of employment at forma
domicele. removal of tamily to new domicile, purchase of home, etc.)
N SCHOOL: ' NOMESTEAD EXEMPTION:
ENTERING CHILDREN I ~
If entering children in school,
please list their names:
r, r~A N ~7.
Zp~inl S. ~
,
~
ti : `~~i.~3afo J
fiLF"v y~w
ST_LUC=i •:•~u`1TY FlA-
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Ml~t [5 Il oi PN'7~1
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with aii other requirements of a legal resident of this State.
-I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ST. LUCIE Count
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~ - ° . . . , ' = S IGNATURE
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~ ~~iyb~ri;to•a+~~s~k Cribed bcfor~ me tl~is ~~ay of
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~ i ing ~ re s s
~ ROG~R POITRAS, CLERK CI.,UIT COURT ~ , Florida
~ F% ~iGi'GG
~ e ut Clerk
By P Y ~
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(To be eaec ed in Jupfic~te anJ ori~in:J f~1~J ~~ilh Clrrk Circuit Courl, and Juplicalr vvilh Ta~ Assesux)
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