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Declaration of Domicite and Citizenship :
TO'TNf: STA7'G ANUCOUN7'Y TAX ASSk:SSUR, i~r~SJ~ ~i
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~ST. LUCIE _ COUNTY, ~LORIUA:
This is my dcclaration of Domicilc and Citizcnship in thc Statc of riorida th~t 1 am filing this day in ~
accorclancc, and in conforntity with Scction 222.17, Florida Stat~rtcs. ~ ~
1 was fonnerly a Icgal resident of and I
(citY) (stace)
resided at 3 . However, I have changed my domicile to ~
(Street and Numbe~) ~
and am and have been a bona fide resident of the State of Florida since ~ y day of ~
~ ar,. , 19_~, and 1 reside at 3 trt~ .~1.~~~~ '~O'~~a 6
, • (Street snd Number) t
/p~ ~ . ' St . Lucie County, Florida, '
(Ctitr) i
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in thc State ~
of Florida. ~ -
(Insert here any pertineot facls, such u sale of property or business, or relinquithment ot employment at fwmer
domicile, removal of family to new domicile, purchase of home, etc.)
N IN SCHOOL: ' HOMESTEAD EXEMPTION:
ENTERING CHILDRE ~
If entering children in school,
please list their names:
~ ~ i(~ , /.l =~d.1.~a ~ '2'
75;~ ~
C~ f~ie~ r.•.:~ -ECa~o~o
- s ~a,/L ~a~~ 3T.lUC G9SNTYFIA.
Rr•~., ?U:;~AS i
p^ CL~?R ;•UIT COURT ~
Cc.^.• ,r_ .-~rr~
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- Ma~t 15 l143 PH'1~~~;{{/j
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1 FURTHER CERTIFY that I will register at my local address when the registration books reogen, and
comply with ali other reyuirements of a legal resident of this State. , ~
,
I FURTHER CCRT[FY that I have no intention to return to my former domicile, and I intend to remain in ;
~ ~ ST. LUCIE County, 3
,
Florida, ermanentiy. ~c~tr~ -
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~ ~ . - ~ S IGNATURE
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SHroin~to.anft' ubsa7~bed befom me this~-~ day of
.
~'`x'L~--~~ A.D. 19_74 . i ing ress
ROGER POITRAS, CLERK CIRCUIT COURT Florida
_ ~
,
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gy~~,. l~c.~~ Deputy Clerk -
(To be executeJ in Jup6catr and unginal f~l.d wi~h ('Ie~k Circuil Cuurt, and Juplicate with Taa Assessor)
60~ ~~5 "~s~E 7~6
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