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Declaration of Domicite and Citizenship
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7~0 THf: STATE: ANU COUNTY TAX ASSESSUR,
ST. LUCIE ~'~6~6
_ COUNTY, FLORIDA:
Tfiis is my dcclaration of Domicilc and Citiz~nsl~ip in the Statc of Florida that 1 am filing this day in ~
accorJancc, and in conformity with Section 222.17, Florida Statutes. ~ ~
~ i9 and I ~
1 was fornierly a Irgal resident of ~ L ~
(CitY) ~ (St~te) i.
r~~ided at 3 51~~.Q~- . However, 1 have changed my domicile to ~
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(Street and Number) ~ :
and am and have becn a bona fide residcnt of the State of Flarida since ~ day of
-.J V ~ ~ , 19 - and I residc at G ~ T ~ ~ ~
- ~ (Street and NumDer)
~ St. Lucie County, Florida,
.
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cn~y~
and this statement is to be take~~ as my declaration of citizenship, actt:al Icgal msidence_and domicile in the State ~
~r e~or~aa. ~ ~
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(Insert Aere any pcrlinent facts, such u salr of pruperty or business, or rclinquishment ot employment at former }
domicile. removal of tamily to oe.v domicile, purchase oi home, etc.) ~ :
HOMESTEAD EXEMPTION: ~
Er~TERING CHII.DREN IN SCHOOL: ~
If entering children in school,
please list their names:
1'~~4 ~ 1.~.N
e.~ _
i1LEL' ~h' ttC~R0E0 .
s1.LUCf~ LJ:fMTY fL~. ~
ALL-. •'«AS
CL£Q~ 'CUt1 COURt
acr~kf~ vf ' "r'~ ,
; . p~ 6 2 4e PH'7~
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€ iZ886`76
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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 CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
~ t"~,_ ~ V`t,` ST. LUCIE County,
~ i ~
~ Florida, permancntly.
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~ ~'..i'': S~i6NA
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~ 5~vb~'t¢'and s~hs~h~b~tf'1i~fore me this ~ day of .
~ ` ~ t' G
~ ` 74 C~f ~'1?7Jv ~iQ~'
~ ' : A.D. 19 ' 1~~I'i~ig r ss
~ . ~ ~ CLERK CIRCUIT COURT ~p , Florida
~ . '
gy C', ~ LD~ puty Cle rk .
. ~ (To be e:ec ed in duplicate and original filed with Clerk Circuil Court, snd duplicate with Ta: Assessot)
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