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Declaration of Domicile and Citizensh~p
Z'O TtiE STATE AND COUNTY TAX ASSESSOR, ~~~54 • -
ST. LUCIE _COUNTY, FLQRIUA:
This is my dcclaration of Domicile and Citizcnship in the State of Flcrida that I am {iling this day in
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accordancc, and in contormi~y wiii~ acciiui~ ~.~rL• 1 j l~~l~/Q U\Y\NIMJ~ , -
rmerl a le al resident of , ~ ) and I
I was f0 y $ #tY) ' (Stste)
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resided at a 3 + . However, I have char~ged my domicile to :
(Street snd Numbcr) '
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and am and have been a bona fide resident of the State of Florida since day of ~
_ , 19~, and I reside at ~~d ~~m~~ j
~ ~ County, Florida,
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and this statement is to be taken as r~~y dedaration of citizenship, actual legal residence and domicile in the State v
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, (lnsert here anr pertiaent fscts, such as salc of propetiy ot business, or rclinquishment ot employment at tocmer
doanic8e. removsl ot tamily to new domicile. Purchue home, etc.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names: - -
C
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fILED ~'~L
i ~ . ST. WC~.. COUIfTK~FiUM•
F,~G: Ft1iTR~
, CLE~tK ;CU~T COURT .
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I FURTHER CERTIFY that I will register at my 1oca1 address when the registration books reopen, and
comply with aU other requirements of 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 I intend to remain in £
~ Q~ ~ ST. LUCIE , 'County, ~
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Florida, permanendy. (c<<r~
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~Q;~,st~bs~i~before me this ~ day of ?
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- ~ ~ ~Y L, ~ ~ R'' ` A.D. 19 74 -
_ . ~ , - . Florida
RCiITT CO IR ~
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gy :r~~~ Deputy Clerk
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