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Declaration of Domicile and Citiz~nship
.
TO TIiE STATE AND COUNTY TAX ASSESSOR, ~~13~r .
ST. LUCIE ( OUNTY, FLORIDA:
This is my declaration of Domicilc and Citizcnship in the Statc of Florida that I am ~ling this day in '
accordance, and in conformity with Section 222.17, Florida Statutes. ~
1 was formerl a le al resident of G RAN ~O~Z~ , ~ 1N ~~~~Yand I
_ Y S ~~y~r~ (seate)
resided at z~~~~YY~~ l7 . . However, I have changed my domicile to i
(Street and NumEer) t
and am and have been a bona fide resident of the State of Florida since 5 day of F
~ ti/.. N E ~A~~.~-~
, 19~ and I reside at ~sua~,~a N~~~~
_ ~p`(~ j • ~,l,~L 1 'L-~ _ S
l ~C 1 ~ County, Florida, ~
tritr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State '
of Florida.
(lasert Aere aar paYtinent ixts. such u sale oi p~opettr ot business• or K~inquishment of employment at tormer
domicie. removsl of family to new domicile, purchase o[ home, etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: ~
If entering children in school, ~ -
please list their names: ~
. ~
f~LEU a~;g a~CGR0E0
ST. ~UCIE CuJMTY F~A.
RCCE ? ~~,~T,~~S
CLEFt C ~;v;T COORT
REC!'S^ V~-•::
.
~ Je~ 18 10 sc AN 'l~
f
l
28'~132
I FiJRTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with aq other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in i
S~'- ~~C~L` ST. LUCIE 'County,
(c~~r) '
~ Florida, permanently. ` ~
~ . _ ~l.~~i~.
~ ~ ~ ~
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•~,'-.f=V~I.:.CO~~."~~;- ~f°O~~ M . 1f1r~~~ .
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:sf •,.~~:U'%'•`.~~~~N~'
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SwoFn~ o and subs~i~before me this ~O day of
~ ~ ~ ~(a ~.E ~ ~
- ~ w'~~ ~ A.D. 14 74 _ - t
E~:p.... , Florida .
I~jK-r- S
i_(~ l,tC l C' `
;
gy ~ Deputy Clerk
6001( ~.c'7 PACE
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