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Declaration of Domicil~ and Citizenship
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TO TH1: STATE ANU COUNTY TAX ASS~~SSOR, ~
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`ST. LUCIE ~;pUNTY, FLORIUA: #
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~ Tliis is my dcclaratian of Domiciic and Citizcnsl~ip in the Statc of Florida that 1 am filing this day in
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acconlance, and in conforn~ity with Section 222.17, Florida Statutes. !
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1 was fornicrly a icbai rc~ident of ~A~~~p~'a'~ , and 1 ;
(Ly~ (state) ?
resided at C a n ~ . However, 1 have chanbed my domicile to .
( t snd umber) • ~
and am and havc been a bona fide residcnt of the State of Clorida since l day of ~
~ , 192~, and I reside at ~ 7 ~ - .
. (Stteet and Numbe~)
ff ~trGC , ' St . Lucie County, Florida, ~
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and this slatement i~ to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. - ~
(Inserl here any ~tinrot facts, such as sale of praperty or ~usiness, or telinquishment ot employmenl at former
domicile. removsl ot family to new domicile, purcAase of home, etc.)
• ~ HOMESTEAD EXEMPTION: ~
ENTERING CHILDREN IN SCHOOL. ~
If entering children in school, `
please list their names: ~
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fItED ~h~ ~ECORDE~ ?
ST. LUCt: iOUNTr FLA, ~ t
fii~~_ : = JI'R4S
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Ma~ ~l ii is qH'7~
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f 2'7'78~3 ~
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and t
comply with all 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
~j~ ~e~e ~ ST. LUCIE , County,
Flvrida, permanently. (c~tr) "
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~ , ' , ~ •
~ . : = GI~A ( ~e G ~ )
~ • ~ • ' - : ~ ~ day of
Y S~rocn t~and s~ ct{h~d before me this
~ _ - ~ ~ 74 . //L Z S° ~T~ .ST
~ ' ~ t~%1vK~ A. D. 19
'~'ai ii'~~ ress
~ ROGCR POITRAS, CLERK CIRCUIT CnURT ~-t
,c~~ ~ , Florida
gy 1 c,~ a. Deputy Cle rk •
~ (Tu bc ~ _utrd in Juplic:de and c~~iRinr) f~~- Cle~k Citcuit Court, and dupli.ale wilh Tax Asseuot)
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~ ' ~0~~225 ~~cE~O~
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