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Qeclaration of Domicile and Citizenship
286081
"TO TtIL• STATE AND COUNTY TAX ASSESSOR,
ST ~ LUCIE COUNTY, FLORIDA:
This is my declaratiun of Domicilc and Citizcnsliip in the State of Florida that 1 am filing this day in
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accordance, and in coniormity with Section 222.17, Florida Statutes.
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1 was formerly a legal resident of _ ~ •
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resic;~d at . However, ! have changed my domicile to
(Street aad Numbe~) +
and am and have been a bona fide nsident of the State of Florida since f dsy of
~ i~? y~ 9~.L, and l~ reside at l. r`' t`~' •~-c.:t' F
(Sueet and Number)
c,--~- ~ r E. r ~ r' , , ~ ra ~ < i r : 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.
(Insert here any pertinent tscts, such u ssle ot property or busineu, or ~elinquishment ot employment at tormes
domicde, removsl of family to new domicile, purcAase of home, etc.1
ENTERING CHILDREN IN SCNOOL: Q. HOMESTEAD EXC1~iPTION: ~
If entering children in school,
please list their names:
L +1..1r~i /v`Gl,ii~)OY
U! 6t C P ~~~G~.~ Y~O. -
r l~~ h ~`~1~'` v n o.-- ~ I~rC76QV1
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i/1~T tl v i+' tt~ S ~ i1LE0 Afli~ =EC'v~tIEO
st ~ucc~ c~uMTY FLA.
ROC~ ~ ~ ~=.'~~?S
CLERK ;::_!'~1:' ~OURT
RF':OR( Yf~:~;~?_,.~~
~ ~YL ~J IZ 43 Pty.'7~
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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.
I FURTHER CERTIFY that 1 have no intention to return to my former domieile, and I intend to remain in
r ~j ST. LUCIE County,
T GI'~ `/Cf~r - .
Florida, permanently.
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"•$~irarrn fQ and 'sceh~bed beforc me this ~ day of
~ ~ ~ ~ . . D. 19~_. ~ ~ " f ~ -
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S•IRC
1~IT GaUBT- 1~'~-t ~i ~ c-e._ , Florida
ROGE ~ POIT , CLEBK
gy ~,t'~, (c'e~z l f~ De~uty Cle rk
600K PAf?E 1O~.z
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