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Deciaration of Domicite and Citizenship , ~ i
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'f0 TtIE STAT[: ANU COUNTY TAX ASSESSOR, !~~4~~9 f`
ST. LUCIE ~COUNTY, FLORIDA:
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This is my declaration of Damicile and Citizenship in tht State of Florida that 1 am filing this day in
accordance, and in conformity with Section 2?2.17, Florida Statutes.
I was formerly a Icgal msident of _ s~ ~P;~ Cc~~-~ , /~e~v y~' and I
(Citr) ( ste)
residcd at ~ 5~`'~'^' Td iv S~': . However, 1 have changed my domicile to ;
(Street and Number) ~
and am and have been a bona fidc resident of the State of Florida since ~B~ - day ot .
~ ~G s~"• ~ ~ c ~`e~ 14v~' . ~
?~ni , 19~ and 1 reside at ~ ~
~ (Street and NumAer) ~
~T, ~ ~ 2 c c~ , S~ ~ ~ , County, Florida, _
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(ci~r) ;
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inse~t Aere ang pertinent (acts, such u sale of property or business, or relinquishment of emplorment at former
domicile, remoral ot fsmily to new domicile, purchase of home, etc.)
LDREN IN SCNOOL: NOMESTEAD EXEMPTION:
ENTERING CHI
If entering children in school, ~
please list their names: ~
Fn~a Ako ~~coaof~
sz.~vc+~ r.~n ~t~?.
i ROCE : ?i:ITR~S E
CiERK Cs~.CU~~ COURT '
I 1
~ . RfCOFQ VER~=~Ea
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' _ ~ ~ 10 ~H'~~
~509
1 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.
- I FURTHER CERTIFY that I have no intention to return to my fornier domicile, and I intend to remain in
~T"y-- ~ ~ ~ ~ ST . LUCIE , County,
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Ftorida, permanently. . ccitr~ ~
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Sw ~ori~ ~nd sub~}'~~before me this U / Q~ U(~ .
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A.D. 19_7_4_.. .
, t,.a`2. BT__ ~ ~.~.e. U ~ rlorida
ROGE$'p... ,
gy ~ Deputy Clerk
S40K~O PACf~V~S
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