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Declaration of Dom~c~le and Citiienship
TO THE STATC ANU COUNTY TAX ASSESSOR, '~~599
ST. LUCIE COUNTY, FLORIDA: -
This is my declaration of Domicile and Citizcnship in the State of Florida that I am filing this day in i,
accordance, and in conformity with Scction 222.1 Florida Statutes. ~
1 was formerly a legal resident of ~/~r9rA~/9U ,~E ?f~~~ and I
~ - y~ (State)
resided at ~~~~Q~TOJY ~,~E . However, 1 have changed my domicile to -
(Street and Numbe~)
and am and have been a bona fide resident of the State of Florida since ~ day of
JC(~ 19.Z~, and 1 teside at ~~'Z ~ E~`~~~~
' (Street sad Numbet)
f~0,~r ~ ~~r%~ , County, Florida,
(aer)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. - ~~/,~1~/AS~ D~ /}O/hE
(Inseri here anr pertinent hcts, such as sak ot prope~tr or business. or reliuquishment ot employment at tormer
domic~lc. removsl ot tamilr to aew domicile. purchase ot Aome, etc.)
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names:
fILEO ~ h .
_ i ST. LUCt~ ~~~MTY f~,j ~
~G~zi: 'r'~:t'RA$
CLE~r
arr~~,,, -._'Up COURT ,`~1't
'
••_•f t~
~u~ 1~1 i f s2 AN ' T~F
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~ ~~~~99
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4a
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I FURTHER CERTIFY that I will register at my locai address when the registration books reopen, and
comply with all othei requirements ef 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
~Jr~.~ E ~JO~/ ~,y [ //1 ~0/l ~ , ST . LUCIE , 'County,
Florida, permanently. cc~~r) /~.c..F,t'~c' fv'e %yP~
~ '
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t
,Y~ ~~U~.~~`~~ii~'~~ - I •
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ld~~ /r+? ~ l~ ~
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N .,•,'s~1v~: ,~'~'~?.-t Li ~ s b ~~h
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Sw~r~i~~dsubscn~~fore me this ~ day of 3~Z ~t ' ~-aLlvQ ~ ~
w' ' J ~ ~
~ • ~ , " . . -
~ ~ ~ : ~ '~r i : ~ A.D. 19 74 -
~ , • -
~ `r - /~piQT ~fT LG![ it- Florida
R , .~s
IT .Ot1RT ' ~
~ ,'?'}2:4t'•`.4~~ - . i
~ By c Deputy Clerk
- .
~
~ OR~
~ BOOK~ PA6f ~~7V
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