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Declaration of Domicile and Citiienship
TO THE STATE AND COUNTY TAX ASSESSOR,
s
ST. LUCIE COUNTY, FLORIDA: ~
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This is my declaration of
Domicile and Citizcnship in the State of Florida that I am filing lhis day in ~
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accordance, and in conforniity with Section 222.17, Florida Statutes. ~
1 was formerly a legai resident of J D v T N o t~D , 1~ • and I
(Citr) State)
resided at 1~ ~ N~ j~ I~ Ro A D 1~ d~C 3 5 xHowever, I have changed my ~domicite to • _
(Strcet and Numbet)
and am and have been a bona tide resident of the State of Florida since day of
19~~, and I reside at S M i NE
~ (Street snd Number)
~ ~ G~ St . Lucie County, Florida,
.
(~~r)
and this statement is to be taken as my declaration af citizenship, actual legal residence and domicile in the State
of Florida. ~v ~ G~^ g E ~ F p M E'
(Inse~i here any {+ertinent tacts, such u sale of pruperty or business, ot telinquishment ot employment at fotmer • ~
domicile, remo~al of tamily to new domicile, purchase ot home, etc.) ~
i
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school, ~
please list their,names:
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~~`Il GE~+ ~4 TAAS ~A~
~~~AK CIRCUIT COU~T ~
i - REQORa VERIi1~D~~. F
a
M~r 10 3 09 PN'1 ~
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I FURTHER CERTIFY that I wili register at my local address when the registration books reopen, and
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 i~
~O R G L ST. LUCIE , County,
Florida, pernian~ntly. tc~~r~
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~ j . , L • ~
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- ~ CL'I.c-C-t-~
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, t..' . -
, - - ~ - SIGNATURE
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Sworn io an ^subscribed before me tl~is ~G' day of
74 l!/ 3 S M IIvE 1~~
~Gv ~ A.D. 19 .
i ing ress
ROGER P TRAS, CLERK CIRCUIT COURT f'/~ R~ E' , Florida _
. -Q
gy - o-Ll~~eputy Clerk '
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(To be executed in duplicale and origin~l f~lyd wilh Ur RCire ft Court, and duplicale wilh Tsx Assessor) ~
BOOK 2~ 7 PACE 1V ~5 ,
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