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Declaration of Domicile and Citizenship
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TO TIiC STATE AND COUNTY TAX ASSESSOR, 2~4~91 ~
ST. LUCIE _COUNTY, FLORlUA:
This is my dcclaration of Domicilc and Citizcnship in thc State of Florida that I am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes. t.
~+sL~~eJ G~2C~/c A/~ w~CR.Sr y and I }
! was formerly a legal resident of ~ ~ '
(~tr) (state) `
resided at x~-~ O C~ . However, I have changed my domicile to
(5t~eet and Number)
and am and have been a bona Cde resident of the State of Florida since a ~ day of ;
\ :t
, 19._7 and 1 reside at e-~ ~ ~3 u k~~ S ~o T-~ S
(Street and Numbet)
~j C,~ ~G ~T ~ v C= County, Florida,
.
(c~~r) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any perlinent tacts, such u ssle of property o~ business, or relinquithment ot empbyment at formet t
domicJe, removal of famiir to new domicile, purcAsse o( home, etc.)
ENTERING CHILDREN IN SCHOOL: n HOMESTEAD EX~MPTION: ~
If entering children in school,
please list their names:
FIIED AND RECORDED ~
ST. LUCIE Ct)UMTY FLA.
ROGE R POITRAS ~
~Oa~""~~ \ CIERK Ct~CU1T CQURT
-s RECOR'J VEF.iFIEO
.lu~ 13 I 4o PH'~~I
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! . ~84~91
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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 requirements of a legal resident of this State.
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1 FURTNER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ `v7~G~- _ ST. LUCIE County,
~ Florida, permanently. ec~cr) ~
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~ $wo~n~o;and s~c~r~¢;hefore me this j~~ day of
~ u, ' 3 ~ : ` :.t I v~ ~ ~ -~c.? 5 . ~
~ ~!~s,F;~<, ' c' A.D. 19 74
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~ ~ r' K~,~~iTTT C~BT- ~t G C , Florida
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~ iDe ut Clerk
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