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Dectaration of Domicile and Citizenship ~
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TO T~iE STATE AND COUNTY TAX ASSESSOR, ~~4188 '
ST. LUCIE CO1JNTy, FLORIDA: -
This is my declara~ion of Domicile and Citizcnship in the Statc of Ftorida that 1 am filing this day in
accordance, and in con[ormity with Section 222.17, Florida Statutes.
I was fornnerty a legal resident of de ~~v~ , and I • ;
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rc;sedcd at f 1~ j"' ~ J~~~ . However, I have changed my domicile to
(Ser«t s.d Nwse~)
and am and have been a bona Gde resident of the State of Florida si~ rn~ day of ~
, l9 74' , and I reside at ~ ~ ~ L ~ ~ .
(suKi a~a N~~+e~~)
~ e~ ~ ~ . S ~ ~ t~ C / ~ County, Florida, ~
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and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State i
of Florida
~~T ~~~t fx~ ~~y y~ ~t pwpe~;~ ot business, or relinquishmcnt ot employment at [ormer
~o~icie. re~ord ot h~rJ= to ~ew dom+cile. pu~cdsse of Aome. etc.)
ENTERI*:G CIiILDRE~I IN SCHOOL: Q NOMESTEAD EXEr1PTI0N: ~
If entering children in school, .
please list their izames:
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I FURTHER CERTtFY that I will register at my local address when the registration books reopen, and
comply vrith a11 other re9uirements ~f a legal resident of this State.
I FUR'I'HER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
ST. LUCIE , County,
rmanend tr.c:) •
Florida, pe Y- .
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,sub~?bed before me this day of C
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