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' ' ' nd itizenshi ~
Declaratian of Domicile a C p
_ .
TO THE STATE AND COUNTY TAX ASSESSOR, . .
ST. LUCIE CpUJ~'~'Y, FLORIDA:
This is my declaration ot Domicile and Citixenship in the State of Florida that 1 am ~ filing this day in~
~
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accordance, and in conformity witn ~ection i~~. i;, ric~riu~ ~:aiui~~.
1 was foimerly a legal resident of ~ ~d j
(c~ty) (si.a)
resided at ~ ~ Sm- mQ%M S t . However, I have changed my damicite to
~sa~~ ~a N~~e«) ~
and am and have been a bona fide resident of the State of Florida since ~ ~s day of
, 19~___, and 1 reside at ~~G~
(Stnet snd NwnbK)
.~s 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. .
(Imett here ~ny pertinent tacti, such as sale of prope~ty o~ business. o~ relinquishment ot empio7ment ~t totasr .
domie~7e. remorsl ot tamilr to aew domicile. Purchase ot Aome, ete.) ~ -
REN IN SCHOOL: HOMESTEAD EXEMPTION: a
ENTERING CRILD 1G`1.
If entering children in school, _
please list their names:
~ ~1~ ~9~~ Q /
~i~~.~ ~ ~a ?r a '
~.~x-~ ~?p ,~n, - ~ .
_ - - 1}'
FILED tti~ F~CORDEd ~ .
ST. LUCiE =:O~NTY flA.
RO:f = ~ ~~S
~«q!~ C~.: ~UI ~ COURT
REC4Rr 1`E'< ~~Ea
' ~C 5 33 ~'7~
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~ ~ - _ 288526
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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 FURTHER C~RTIFY that I have no intention to return to my former domicile, and I intend to remain in F
~ ~ ST. LUCIE
y L~~~ - , County,
Florida, permanently. «'`r~
~ , ~ ~ ~r~ A
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~ .•'0.(;L11!`~'•• r'
~ ~ •g~ , fore me this ~ day of _
Swor~. ,~d' ~ _ ~.J~._
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~ = r- ; ~Yr,-'Y A.D. 19~~..
~ _ ~ .
: u,': ~'-T ~ =d:~- , Florida
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:
gy ~ ' Deputy Clerk
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