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Dectaration of Domicile and Citizenship
TO 7'~iF STATt: ANU COUNTY 7'AX ASSk:SSOR, ~~183 -
ST. LUCIE L~pUNTY, FLORIUA:
'Iliis is my deciaratio~ of Domicile and Citizcnship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section 2"_'2.17, Florida Statutes. ~
1 was formerly a icgal resident of ` Z{-~~ ~ and I
•~r~ ' (stacc) ~
resided at C_ . However, I have changed my domicile to
(Street and Number) ~
and am and have been a bona . fide resident of the State of Florida since day of
, 19-L.., and 1 reside at ~
(S t sad Numbet) ~
County, Florida, -
. i
(Ctitr) •
and this statement is to be taken as my declaration of citiaenship, actual legal n~s'sc!en~e and domicile in the Stat~
of Florida.
(Insett Aere anr pcrtioent tacu, sucA as sale ot propertr o~ M~siness• ot re~~u9uisRment ot employment at tormer
domic7e, remoral of tsmilr to new domicile, purchax ~f home, etc.)
ENTERING CHILDREN IN SCNOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
p se list th ir names•
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~jT COlfRT
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2 58 PN'7
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28'~183
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 resid'ent of this State.
I FURT ER CERTIFY that [ have no intention to return to my fornier domicile, and 1 intend to remain in
~
~ ~ ST. LUCIE , 'County, ~
~ ~J~ ,t 4_
Florida, permanently. «'tr)
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S~iqi ' tQ at1d ~subsc ;~efore me this ~ day of _ ±
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'r• . - ~ ~.,~1,~~ t, 77~ f)`
i~' A.D. 19 74 ~ :
` =fi ~ ~ :I~;LC~ , Florida ~
~-ROGE~f' QiIRT--- ~
gy; c Deputy Clerk
aocK 2`~ rACC ~J~~
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