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Declaration of Domicite and Citizenship
TO T~lE STATE AND COUNTY TAX ASSESSOR, . •
ST. LUCIE - ~CpUNTY, FLORIDA: •
This is my dccla~atiun of Domicilc and Citizenship in thc State of Florida that 1 am Gling this day in
accordance, and in conformity with Scction 22.17, Florida Statutes.
~ L~-' - and 1
I was fomnerly a legal resident of ~'CS !~E - , ~
tCicr) (Sute) -
resided at ~o.C T X . However, I have changed my domicile to ~
(Stree? and Number
and am and have bcen a bona - fide resident of the State of Florida since .-1-5 ~ day of ~
, 19_._7.~, and I reside at 3~ 3 ~ ~ ~ ~ ~ 6T - '
/ t aad NumEe~) ~
~ ~=L i4 ~ ~7~ ~i~ ~ i.~ County, Florida, '
~
(air)
and this statement is to be taken as my declaration of ci:izenship, actual legal residenee and domicile in the State :
of Florida.
pnsett Aere any pertinent fxts, such u sale of propertr o~ business. or reliaquishment of employment ~t formu
8omic7e~ temovsl of tamilr to aew domicile. purcAase ot home. etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names:
~ c i E' ~ 4f o: ~~r~`
~~r
_ - - - ~~'~~~~~r~~
I~RR CI~CUH;~Q~
-ftf~FiL~ YEAfFt~O
~ dl~ ~ ~ ~.~~~~~'~~i .
- . .f~/ /T ~s PM '~y
2~'7t)'~0
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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 ef a legaf resident of this State.
, FURTHER CERTIFY th t I have no intention to return to my farr~er domicile, and I intend to remain in
~ _ -ST . LUC IE ' County,
C~t % «-~t- - ' :
_ {
~ lorida, permanenily. -
. ~ -
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.
liT3 i
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SWO~•~v ~It~~~ 'p~~b~fore me this ~J day of ,
: cn
a - =+J~: - ! c ; ~ /f/E L" ~7'7 E ~ D 7'--
s-. 4_- A.a. 19 74 _
.
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: d' T .~u c~ ~ ~ , Florida .
jt • R('iTTT CQ~1RT
, .
gy ~ Deputy Clerk
600K~ PACE~~
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