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Deciaratian af Domicil~ and Citizenship
TO THG STATG ANU COUNTY TAX ASSE~.SSOR, 2~~~
ST. LUCIE CpUNTY, FLORIDA:
T1iis is my dcclaration of Domicilc and Citiccnship in tl~e Statc of Florida that 1 am filing lhis day in
accordancc, and in conforniity with Sectian 222.17, Florida Statutcs.
• ~ ' and I
1 was formerly a legal resident of ~d~~~1 , ~
(~ytr) (State)
resided at ~~S G ~d p''"~'""'~1` . However, I have changed my domicile to
(Str et and Number) ~
and am and have been a bona fide resident of the State of Florida since day of
~~~'~i. , 19_~ and 1 residc at ~ Nd •
~ (Stteet and Number)
?
St . Lucie County, Florida,
.
(citr)
and ti~is statement is to be taken as my declaration of citizenship, actual legal nsidence and domicile in the State
of Florida. . . , ~
(insert here any pertinenl facts, such u sale of property or busioess, or relinquishment of employment at formet
domicile. temo~ral of family to aew domicJe, putchase o home, etc.) ~
ENTERING, CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION:
-If entering cY~ildren in school,
please list their names: ~
. •
~ ~
~ i
fiLED AItG R -
sT, wc~ cou+~r~~i. ~ t,
~or.~~ rorr+us
C~ERiI CUCUIT 1`~1~'f
Rf.CORO vER~F1fD
~t~t 9 2 i? PM'~+~
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_I FURTHER CERTIFY tliat I will register at my local address when the registration books reopen, and
comply with all other requirements of a Iegal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my fornier domicile, and I intend to remain in z
ST. LUCIE County,
, ,
Florida, p~rnt~~ently. cc~~r)
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Swei~-to ~c~sutj~,rigeJ b~forc me this _~t day of ~ #
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• ' - ' 74 ~ ~ ~ ~
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` _ - • i ing ress ;
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RpG~='~~- ,~RAS, CI,ERK C PCUIT COURT Florida ;
~
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Deputy Clerk ~
- ny _ 80mt ~JtLE ~~5~ . `
(To be e cu1eJ i~i dupl~cat. ~nd uti,:inrl fi1eJ ~~•ith Clerk ('ircuil Courl. and dupli.ale Nith Ta~ Asst~s ~
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