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Deciaration of Damici~~ as~d ~c~~ze~~sh~n ~
.
ro -r~t~: s~r~-r~, n~.u cOUnTY 1'AX ASSI:SSUIt, 2bQ1Q1
ST. LUCIE _ COUNTY, I~LORIDA:
11~is is my ~l~ claration of llomicile and Citizrnship in thc Statc of rlorida that I am filing this day in
ac~orclance, ~nd in conformity with Sr:ction ~~2.17, Florida ~tatutcs.
~rn ~r v - , 5~ ' l - and I '
1 was formcrly a lcgal resident of ~ c?`~'~, ~c~~Y~ , (s„«)
~ owevcr, 1 havc changcd my domicile to
rc.idcd at .~~-~---~a.~-y---a~.. -~+-*`~S ~
(Stteet and Numbe~)
day of ~
ancl am and havc be~n a bona fide r~sident oC the State of Florida since ;
19__~., and 1 reside at ~l
~~!r
+ (Street and Number)
~a rf ~f' ~ 'e- _ St. Lucie County, Florida,
(c~ty)
and this statement is to be taken as my declaration of citizenship, actual kbal residence and domicile in the State
of Florida. .
(Inseti herr any pertinent tacts, such u sa~e ot properlY or busincss, or relinquishment of employment at tormer
domicile, removai of family to new domicilr, purchax of home, etc•)
ENTERIidG, CHILDRE*1 IN SCHOOL: ~ HOr~STEAD EXEMPTIOi`I:
If entering children in school,
please list their nac~es:
Fr ~ S~ ~ ~ ~Y.. 7 _ v; ~
~r~ l~ C i e Q-c~~~ ~ v, s_
v; d T/, t~=,~: ~ 3
FIlFO AyD AECQRDEO '
SL ~UCIE COUMTY FU.
' lIOCEF. ?pi ~ RAS '
CtERK Ci?CtiiT COURT i.
R~~!TF1 YEP't1E~.~..,~.,,~
Ii ~ ZZ 9 22 ~'7~
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9
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~ 1 FURTHER CL'RTIFY that I will rcgister at my local addmss when the registration books reopen, and
~ comply with :~It othcr requireme~~ts of a le~al r~sidcnt of ihis Statc.
~
~ I FURTIiER C~:lZT1FY that 1 have no inte»tio~i to reti~rn to my fornier domicile, and I intcnd to remain in
~ ST. LUCIE
• , COUnty,
c S~ ~ ~ N
~ l~lorida, pcnnanently. cc~tr~
i ~
~ ~~-c~ ~
_ . DKE
. _
•'~:L iJ.i T • -
~
~ ~u' ~C~ ~ - S IGi3ATURE -
_ • ;
.'~~:i_'• ~ ~ ~ '
„i~.:a • V . . ' i f
s~;~: - ~ day of ~
~qnt to~and su_li~ri~ieii Lefore me this .
_'~yv -
~ ± ~ f ~ A.U. 19__74- ~i inr ress
~ ` CCL'RT ~ Florida
t~.: ~"~'~CP~~ 0,'~~'~t~s , CI~RK C :tCUI~_,_,_r__ ,
1I~~...~.~
~~~R p ~ ~ 226 1420
~y_ e uty .,J.er~: ?'~Gt
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s ~ (To hr c~rt c in JupL:at~ .u,~! ~~ri~m~t fi=rd ~iilh ('I:rl (l.cuit l'•~u~:.anJ Jupli,atc v.ith 7+~ A.~cuorl
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