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Declaration of Domicile and Citizenship ~
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TU 1'HE STATE AND COUNTY TAX ASSLSSOR, ~92Oa3
ST. LUCIE __CpUN1'Y, FLORIDA:
'iliis is my dcclar:~tion of Domicile and Citixcnship in the Statc of Fiorida that 1 am filing this day in
accordance, and in conformity with Section 22.17, Florida Statutes. ~
1 was fonnerly a legal resident of , and I
(Ci ) (sute)
resided at . However, I have ehanged my c~ic~ile to
(Streel an 6mEer)
and m and have been a bona Gde resident of the State of Florida since ~°2' ' day of
~ 19 y and 1 reside at `
.
. ~ (Street and Number
County, Florida,
(CitY) •
and this statement is to be taken as my deciaration of citizenship, actual legal residence and domicile in the State .
of Florida.
(lnxrt hae anr pcrtineot fscts. such as ssle ot property or business, or relinquishment ot employmmt st fotmct
domicile, removal of tamily to new domicile. purcQase ot home, ete.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
plea e ist their n~mes:
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~ fIlEO ANC +~ECOA~ED
~yC1E GJUNjY FL~• ~ '
, . St~ ROCE~~ yUIY
COURT ~
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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 F ER CERTI Y that I hav o intention to return to my former domicile, and I intend to remain in
.
ST. LUCIE County,
,
Florida,;p,ermanentlX._ ccs~r~
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gw' ~'Q. ~ ` fore me this ~ day of
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...'~j_~r. .ar.~~! .
' ~ J A.D. 19 74 _
.t
ROGER, P~ ~ g iITT c~ttR , Florida
gy puty Clerk
` • 600K~O PACE~~~
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