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Declaration of Domicile and Citizenshi~
7'O ~~Hl: STATf: ANU CUUNTY 'fAX ASSI~SSOR, 2~~t`~9'7
_ ST. LUCIE ~-UUN~'Y, FLOItiDA:
71iis is my drelaration of Uomiciic a~,a c~t~~~~~~i»~~ in the Statc of Florida that 1 am filing this day in
accordance, and in canfonnity with Sc~rtion 222.17, Florida Statutcs.
I was formcrly a Icgal resident oC ~ t~~ f Z~~.7 -=~~~nd I
(cti~y~ (su~~~
resided at l~ ~'c~. r• r es s_~~ . However, I have changed my domicile to
( lreet and Number) ~
and am and have been a bona fide resident Qf the State of Florida since day of
: , 19~ and 1 reside 3L - ly' ' `
(Street ao umbet)
s t~ ! « ~ County, Florida,
~~C /'r r ~r ~ ~ r
(CiIY) '
and this staiement is to be taken as my declaratio:~ of citizenship, actual legal residence and domicile in the State
af Fforida.
~ (Insert here any pertlnent facts, such u sale ot property ot business, or relinquishment ot employment at totmet
domicile. removai ui family to new domicile, purchau of home. ete.)
ENTERI*IG CHILDREN IN SCHOOL: HOMESTEAD EX~MPTION: ~
If entering children in school,
please list their names:
r r.~' ~-~b f x~ti i~ ~-1 n~' 3~~
~
,
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i11E0 a!~_ ~E~~~~o a~
ST. lUCic ~pUpTY f~~
RO•",~? Pi,•T~AS t
! - ' C~~'!; " ~~dIT ~
ac~rG- ,fr::,:l; COUR
~ Auc 16 , .
~ 2 j2 PH 7~
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I FURTNER CERTIFY that I will rcgister at my locai address when the registration books reopen, and
compty with all other requirements et a legal resident of this State.
I FURTHER CERTIFY-that I l~ave no intention to return to my fornier domicile, and I intend to rcmain in
~
~ ; f- ~_G ~ ~ ~ - , ST . LUCIE , County,
Florida, pcrn~anently. (c~tr)
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~~`.:y • t+~ / , -
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~ Sw.orit fo and ,~u~'sc ~tied before me this day of 5' ' ' '~r~ ~s ~ 3 '
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, ~ ~ ~ : _ v ~ ~~.o ~ ~ v -
~ ( ~ ~ A. D. 19-~~- _~~C~L
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a_ - v , i
~ R ,~'A~~I,E CUIT COUBT__ y i iz t' , Florida
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By , Deputy Clerk
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. Bfl01( ~t~tJ p/16~ ~
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~...S~.JC s-n . `..:1-.. :
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