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Declaration of Domicile and Citizenship •
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"f0 THE STAT:: AND COUNTY TAX ASSI:SSOR, ~'7198 •
ST. LUCIE _COUNTY. FLORIUA: ~
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71?is is my dcclaration of Dc~micilc :~nJ Citizcnsi~ip in thc State of Hlorida that I am filing this day in i
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accordancc, and in conformity with Section 222.17, Florida Statutes. /
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1 was forn:erly a leg~l resident of H~~~~ , ~v'~ and 1 =
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/~J. ~ e'J . However, I have changed my domicile to ~ 4
residcd at t
(St~tet and Number) ~
and am and have been a bona fide resident of the State of Florida since day of
~ ~.BE.e:
S ~,~F~~d
~v'/I ~ , 191~, and 1 reside at ~ '(SuKt sed NumDer)
y~~ ~ ~~,~CC •C~- c-'/ ~ County, Florida, ~
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' (citr)
and this statement is to be taken as my declaration of citizenship, actual legal tesidence and domicile in the State
of Florida.
(l~ert here any pertineot facts, such u sale of property or busioess. ot relinquisAment ot emplorment at tormer
domic~le, remora! of tamily to ~ew domicile, QurcAase of home. ete.)
ENTERING CHILDREy IN SCHOOL: HOt1ESTEAD EXEMPTION: ~
If entering children in school, -
pl se list thei namesh
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I FURTHER CERTIFY that I will regaster at my local address when the registration boolcs reopen, and ~
camply with all other requirements ef a legal resident of this State. ~
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I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain in
~2 j ~E~ f~ ST. LUCIE , ~County,
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Florida1-Periua~lendp. ~ t~`cy~ - .
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Sworn to afid subscribed before me ti~is ~y day of
c A.D. 19.~~~ "
, Florida
RO~ER P RA~~..~I.E ~IRCIIIT~llRT.__
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By ~ , C ~L. Deputy Clerl:
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B0~(~ ~~~+51t.e)
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