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Deciaration of Domicile and Citizenship
TO TIfG STA'fl: AhU C'OUNTY 7'AX ASSt:SSOR, ~8~~ ~?7
`ST.~ LU~IC _(:OUNTY, ('LORIDA: j
This is my declaratian of Uomicile and Ciiizenship in the State of Fla~ida that 1 am filing this day in
accordancc, and in conforniity with Scction 222.17, Florida Statutcs.
I was formcrly a Icgal residcnt of ~_~.1~G ~o~' l'i , ~f. S- S and I
/ (c~~r) (sae~)
resided at //li 4 L, ~~/C G I~t/ ,s~ i/C ~~2. However, I have changed my domicile to
(Street and Numbet)
and am and have been a bona Gde residcnt of the State of Florida since day of
~ cA~~~-~
1 , 19~ and I reside at "
. (Sueet an~Number)
~ - ~ UC ~ `P , S C / ~ County, Florida,
(citr)
and this statement is to be taken as my~ declaration of citizenship, actual legal residence and domicile in the State
of Florida.
• (lnsert he~e snr pcttinent fscts, such as sale of property or business, or relinquishment ot emplo)ment at formet
domicile. remova! ot family to new domicile, purchase ot home. etc.)
ENTERING CHILDREN ~N SCHOOL: HOMESTEAD EXEMPTION: ~ _
~
If entering children in school,
please list their names:
~r':d ~.s /r-/A -e- -
,b,b PCC ~ ~s cl
:
FIlEO~~U hECitR0E0
ST. LU~(E :;uUNTIf fLA. /J
RO:;ir~ F~:TRAS
. CLEkX. C~F:;U~T COURT
RECORD VEs!!Flrp
~ A~ 13 2 49 PM'1~
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~ 289~ 5'7
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I FURTHER CERTIFY that I will register at my local address when .the registratiar. books reopen, and
comply with aU othcr requirements Qf a legal resident of this State.
I FURTHER CERTIFY that 1 havc no intention to return t0 my formcr domicile, and 1 intend to remain in
~4G 2 -t ~ UG ~p , ST. LUCIE , County,
Florida, permanently. c~'`r)
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=_~tyorn _to an~sc~tiscri~ied before me this 1~. day of
~ ~ ~ V~:'- A.D. 19_74 ~ .
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~ C ~ Florida
; Rd(~'r~ : ~F _ ~~I.C RK IR~IIIZGDllR~
By , ~ C ~ Deputy Clerk
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' b00K
~~U PALE 2369
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