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Declaration of Domicile and Citizenship
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'I'O TtfE STATE AND COUNTY TAX ASSESSOR, ~ ~s -
ST. LUCIE _ CpUNTY, FL~RIDA:
This is my dcclaration of Domicile a~d Citizenship in thc State of Florida that I am filing this day in~
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accordance, and in conformity with Sectioti lll. i i, rlorjQa:~talu~es. ~ ! -
~ ` • and I
1 was formerly a legal sident o ~ •
~ . However, I have changed my domicile to
resided at
- csu apa N~mon) , .
and am and have been a bona fide resident of the State of Florida since day of
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' ' Ct , 19_L~, a 1 reside at
~ ~ 1 - (Sveet and Number)
~~h , y County, Florida, ~
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
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(Insert Aue sar pertinent tacts, such as sak of propeny or business, or relin9~ishment ot employment at tormer
domitie. removal of family to new domicJe. Purchase of hone. ete.) -
SCHOOL: HOMESTEAD EXEMPTION:-~
ENTERING CHILDREN IN ~
If entering children in school,
~~se list~ eir nam~s:
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f~tEL : • ~ t:.?R:;ED
ST. tUC~_ •.~::hiT fLA. S
RG:,~ i _ :?1$ .
I Clf ~t.T COJRT
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~ . AUG I ~ ST ~M'T~I
28t~326
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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 resident of this State.
I URTHER C Y that I have no intention to return to my former domicite, and I intend to remain in
~ ~ ST . LUCIE , ' County,
Florida, permanently. (c~~r)
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. ' ~ day of ~
' ~d before me this ~ 1 ~ _
_ .,.~Saryqnrto ~in~,s~ -y,~
J~ . ~4- ~s ;7:"~`:~-_ ~~O ~ t
- - • • - .;M~.: p.D. 19~~ ~
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,`R~ ~R#rH~• ~ _ ~ ,C~• , Florida ~
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~ gy Deputy Clerk _
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BOOK ~.JU PACE 1~0~ , ~
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