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Declaration of Domicile and Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this daY in `
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acconiance, and in conformity with Section~ .17, Florida Statutes.
I was formerly a legai resident of u-~~- ~ ~ i
(citr> ' (sta~e) :
resided at ~ . However, I have changed my domicik to i
(Street and Numbet)
and am and have been a bona fide resident of the State of Florida since ~Y ~
~ - , 19.~, and 1 reside at ~ ~ ~ 7 ei~~~ ~ ~ -
( treet a Nuaber)
' C~, St . Lucie County, Florida,
.
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domiciie in the State
of Florida.
(Insert here any petlinent facts, such as sale of property or business, or relinquishment of emploY~~ut at fo~oer
domicJe. cemoval oi familY to new domicile, purchase oi home, etc.) ~
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTIOh:
If entering children in school,
please list their,names:
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~ ~~VL~ \I/~7 / ~ _L~~ ^ •
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~C~ T~~~
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~ 2807Ss
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~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
~ comply with all other rec~uirements of a legal resident of this State.
~ I FURTI-iER CERTlFY that 1 have no intention to return to my former domicile, and 1 intend to remain in
' ST . LUCIE
1 ~ c ~ _ , ~ty,
~
~ Florida, permanently. (c~~r)
~ _ GL.' ! ~ ~ ~ ~i
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~~;1 '~~:li' r~ ~ ~1'1~ ~/~N~PIS~
~ ; ~ . ~ =
' ` S IGNAT'URE ~ ~
~r . - ~ da of ~
~ SWOrn to and~~u~seribed before me this Y
t = • i ' • A.D. l9 74 ~i ~ ~ 1
- ~ • - i ing acrre s 5 .
~-~~I~• ~ fiRAS, CLERK C CUIT COURT ~;t . , Florida
-
gy , Deputy Clerk 6~~ p~t ~~19
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(To be e uted in duplicale and original filed wilh Clerk Citcuil Courl, and duplicste with Ts= A~sestatl
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