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Deciaration of Domicile and Citizenship
"I'O THE STATF ANU COUNTY TAX ASSLiSSOR, ~~r238 -
ST. LUCIE _ CpUNTY, FLORIUA: -
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florid: Statutes. ~
I was formerly a legal resident of ~f'~~ ~ T
N~f/fl?FE and 1
~ tt~tr) (St.te) ~
,
j~,, ~,~~,oy ~io~.~f fi6•sE !/«.,•t • L~~ '~f~ . However, 1 have changed my domicile to ;
residcd at ~
(Stteet and Numbe~)
and am and have been a bona Gde resident of the State of Florida since 3 day of
~,fUNE , 19
7~- and I reside at /OOS` ~'h f~XE~~ ~
(Stteet aad Number)
fT `/Ea'~E Sr. Lc.~~c County, Florida,
.
(Ci~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. '
(Inserf Aere sny perlineat fxts. sucA as sale of propertr or business, o~ telinquishment ot emplorment at [orme?
danic7e. removal of tamily to new domicile. purchsse of home, etc.)
ENTERINC. CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: a
~
If entering children in school,
please list~their names:
~~y
Jv !S'ClP T GqlC o 4/i1 Y
fILfO t«. • c~G~E 0 ~Lu'
ST. ttiwiF ~::.JNTIf'Fl~.
BG~~i_~ ?~TRAS •
~(~::~c ,:~17 COURT
pC!`^R? VF~ i IE~
~ .lw. ly i~ a7 ~H'7~
~ ~8'7~~8
I FURTHER CERTIFY that I will register at mv local address when the registration books reopen, and '
comply with all 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
~~~~E ST. LUCIE 'County, ~
,
Ftorida, permanently. (c~tr~
/
, ~-t~d' ~l~v+-~' ~~~h- -
~
j~ $iPd ~r~c,~p l P~-~-,,~ -
R.
~ - ~ ~ q
Swort~.t~o-~iQstl~~c1?bed b~fore me this -1~_ day of o ~ y~~ ;
• ' - • .:t~ . : C. ' . ~ ~ - ~ >C ,
- ` A.D. 19~ ~ ' ~
- ` - ~ - T ~~~r~ E , Florida i
, p c
iT_~__T co_tlR2-
>,`z _ . . .~~5~.~
O
. r~ ~ - • .
~~~;ti`- L~'~ ' Deputy Clerk
s~~ft BQQK ~~~hrV ~AU~ I~r~~
• •
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