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Declaration of Domicile and Citizenship ~
TO THC SZATE ANU COUNTY TAX ASSESSOR, ~85101
ST. LUCIE CpUNTY, FLORIDA:
This is my decl~ration of Domicilc and Citizcnship in the State of Florida that 1 am filing this day in ~
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accordance, and in confonnity with Section 222.17, Florida Statutes.
AfoR.~r.~~ , Ok ~c A and I •
I was formerly a legal resident of ~~i~r~ ~ i
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resided at ~~a 3 N [ RAt?~"D R D . However, I have changed my domicile to ~
(St~eet and Number)
and am and have been a bona fide resident of the State of Florida since ~-S ~ day of
Nov Ew~3E12 , 19_~.2,_, and 1 reside at /O/ ~l ~t ~SS.~ L~Ne • ~
(Street and Numbe~)
FT' Y~/ E R[ t ~S~ ~ _ County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnxrt here any perlinent taets, such as ssle ot p opetty or business. or relinquishmmt of emploY~uent st former
domic8e, removal ot family to rtew domicile, purc~ oi home, ete.)
• n HOMESTEAD EXEMPTION: a ~
ENTERING CHILDREN IN SCHOOL.
If entering children in school, .
please list their names: 285101
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fiLEO GNU RECOR~fO
SL 1,UCIE ;.OtiNTY FlA.
ROG_n PGfTRAS
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j Establishing residence
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I FURTHER CERTIFY that t will register at my local address when the registration books reopen, and
comply with all other requirements ef a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my forrner domicile, and I intend to remain in
~i f- /ERfr _ ST. LUCIE , County,
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~ Florida, permanently. - ,
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~ ~ . - ; _ : ~ _ V~ ~ ~ day of
~ Swdr~ an ubsc,ettftc~• .~vre me this
~ ~ ~ . •Q,~ /OI /j'/ Cc /:sA 1 ANc?
~ ' A.D. 19 74 -
~ R ~ F;ERc ~ , Florida
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gy ~.fwL. ~~~c~:CDeputy Clerk . S
600K ~S PACE
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