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Declaration of Domicite and Citizenship
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~~O THE STATE AND COUNTY TA1~ ASSESSOR, ~
ST . LUCIE CpUNTY, FLORIDA: ~
This is my declaraiion of Domicile and Cititenship in the State of Ftorida that 1 am Wing this day in
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accordance, and in conformity with Section ii~. i i, riu~;ua ~:a:4~~~• ~
~ ' f and I
1 was formerly a legal resident of ~ ' ~,e~~ _
3 r 7~Q e~ ~`a ~i . However, 1 have changed my domicile to "
resided at
(sasec.paN~me«) /jE
day of
and am and have been a bona fide resident of the State of Florida since k
L~ ~ C ~!"`1 Y hS'~'~E t
_ GL ft- , 19 and I reside at ~ t~ N.~.e«)
~ / ~ c,t, ~'E County, Florida,
~ ~ r f r~ E
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of r iorida.
~ (lwser/ Aere anr Pertincnt (sets. sucl~ as sale of proPertr a pusmeo• o~ r~4a~~eat ot espb7~ntat at totmer
donicie. remorai ot hotilr to new domicite. Durchssi ot 6ome, etc.)
. H~STEAD EXEMPTIONi ~
ENTERING CHILDREN IN SCHOOL. L~
If entering children in school,
please list their names:
'.,,,~rC ~ oaj rie
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I FURTHER CERTIFY that I wili register at my local a
edress when the registration books reopen, and
comp ly wi t h a t
l o t
h e r r
e q u'
u
e m e n t s o f a l e g
a l r
e s i d e n t o f t h~
s S
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ r~ ~ ST . LUCIE , ' County,
Florida, permanently. (c'~') r
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,1_i,.,.GI~ , " .G~
" - • ,
~ - • .
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~ Sworn
to and suli~c~ibed @sfore me this day of 5~C ~ ~C ~ ,~~_e ~
~,j;•
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- ' A.D. 19 74 -
= Yd ~ e r ~ , Florida '
c
ROGER P . _ _ ~
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- gy ~~,C~e'puty Clerk ~ ~
sooK ~a~t ~
~F~ ° R 230 1~ ~
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