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Declaration of Domicile and Gitiz~nship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~ -
ST. LUCIE 28~
COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of ~lorida that I am filing this day in~
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accordance, and in conformity with Section ll~, i i, ~ioriaa ~taiuir.s. n ~ - -
.
1 was formerly a legal resident of • and I
Cfcr) ~
resided at , ~ . However, I have changed my domicile to
( t .ad tvumoer)
and am and have been bona fide resident of the State of Florida since day of
, 19_.~ and I raide at i1~-~~
~i ~ Nw~ee~") v~.
l (
~~f ! ~A ~~p County, Florida,
(~tr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
~f Florida. .
pa~t aae snr ver~ine~t tx~s. wd~ as sa~. ot ~o~rcr or bnsioas. or reliaquishweat ot smplormeat at tormer
dpmiciN. meovsl ot fudlp to ~ew domicils. Purchass ~f hom~. stc.)
REN IN SCHOOL: n. - HOMESTEAD EXEMPTIONt ~
ENTERING CHILD
If entering children in school, .
please list their names: -
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~ . ST.IU~tF ~DUlITY FLA.
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A~c 5 12 26 PH'1~!
288528 -
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 CERTIFY that I ave no intention to return to my foRner domicile, and I intend to remain in
_ ° ST . LUC IE , 'County,
~
Florida, permanently. (~`r~
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S`i{~~ d su ~ied:before me this jL- Y
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• • • ~i4. . A.D. 19 74 _
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- : : `0 ~ , Florida
ROG _ - - -
By u Deputy Clerk -
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