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Dectaration of Domic~le and C~t~zensh~p ;
"1'O 7't1E S1'ATI: ANI) ('UUNTY 7'A!C ASSL:SSOR, 2bi933~
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ST. LUCIE ~OUNTY,I=LURIUA: ~ ~
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This is my dcclaration of Do~nicilc and Citizenship in the Statc uf Florida tl~at 1 am filinb ihis day in ~
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accordance, and in conformity,with Section 222.17, Floricla Statutes.
I was farmerly a iegal residcnt of - and I
(citr) ~ ~ (sate)
resided at ~7~ ~`~O 7 S7` . N~wever, 1 have changed my domicile to
(Street snd Number)
and am and have bcen a bona fide resident of the State of Flonda sincc 6"~~~-~' day ot
, 19_,y and I reside at
~ , ~ Q'~ . (Stroet an N mber)
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, j , j ~ ;/.,cR.c,~'o, _ ,[@ County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and dom:sile in the State
of Florida.
(Insett Aere sny pertinent fscts, such ss sale ot p~opertr or business, or relinquishment of employment st [ormet ~
domieile. removal of lamily to new domicile, purchase of home, etc-)
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ENTERI*IG CHILDREN IN SCNOOL: ~ HOMESTEAD EXEMPTION:
If entering children in school,
please list ir names:
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s'T.LIlC: .~~JVIY fLA.
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1 FURTHER CERTIFY that 1 wiU register at my iocal address when the registration books reopen, and
comply with all other requirements ef a legal resident of this State.
~ I FURTH CERTIFY that I have no intenti~n to return to my former domicile, and I intend to remain in
~ , j ST . LUC IE Count
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~ Florida, permanently. -
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~ Swurn,:to ~nd's~t~ribed before me this __~~L_ day of
~ : t ;'~;G = . A.D. 19_~_.
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~ =~pG ~j ~gK~I f.IJIT_CIIllI~_ , rlorida
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By 0•, . ' eputy Clerk
~ . BOOK ~O PA6E
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