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Declar~tion of Dorniciie and Citizenship ~--4
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1'O THE STATE AND COUNTY TAX ASSESSOR, ~4056
ST. LUCIE CpUNTY, F1.ORIDA:
71iis is my d~claration of Domicilc and Citizenship in the Statc of Florida that 1 am filing this day in
accordancc, and in conformity with Sectio~ 222.1 Florida Statutes.
I was formerly a legal resident of n^~ x Fl S and I ~
(~ytr) ' (State) ~
resided at 0 3 ~e +~'e n~q ~2 c~ ~k •~e-• . However, I have changed my domicile to ;
csaK~ ~oa H~me~) -s ~E..
and am and have been a bona Cde resident of the State of Florida since day of ~
~ - - , 19_ J ~Ly and I reside at c~l o ~ i2 .A n1 R c~. ~k cI . ;
(Street sad NumEer)
~ u~ S-~ v~ c~ e. County, Florida, `
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S-t '
(cs~r?
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State ~
of Florida.
(IaseN here anr pertiaent facts, such as sale d properlr o~ business. or relinquisAmeat of emplorment at tormer
domiule. removal of familr to new domicile, purchsse of home. etc.)
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ENTERING CHILDREN IN SCNOOL: HOMESTEAD EX~MPTION: ~ ~
If~entering children in school, .
please list their names: •
h A R ~e R")A~:e .
~~,e L ~~~pR-~- ~e- ~1AK~ ~ +
FllEO A!1~J R~COROEO L~~
ST.IUCiE COUNTY FlA- l 4.~
IiOCER F6~TRAS
CLERK•CIRCUI? COURt
RfCORfl VERIFIED
' ~tIN 10 ~0 3i
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I FURTNER CERTIFY that 1 will regaster at my local address when the registration books reopen, and
comply with all other requirements ~f a legal resident of this State.
I FURTHER CERTIFY that 1 have no intentio~ return to my former domicile, and 1 intend to remain in
~ ~ ` ~ ST. LUCIE ~ , County,
Florida, permanently. - ~~'`r~
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Sworn to,~pd;surtiScritied before me this ~ day of ~ Q a v. Lv~ ~l N~-~ 1~ e~ .
~ . ' . 4
~ A.D. 19~~
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' ~ • -t- . u c , , Florida
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g~r'. ~ 1' puty Clerk
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