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Deciaration of Domicile and Citizenship
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~549
"t0 TItE STATC ANU COUNTY TAX ASSESSOR,
_ ST. LUCIE _ CpUNTY, FLORIDA: :
This is my ~3cclaratian of Domicile ar?c! Citizenship in the State of Florida that 1 am filinR ihis day in ;
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accordance, and in conformity with Section 222.17, Florida Statutcs. ~ ~
,
1 was formerly a legal.resident.of m~~~ and I
r City) ~ (Staee)
resided at q~'3 ~/o~~ 4? . However, I have changed my domicile to
(saee~ .na Nomee~)
and am and have been a bona fidc resident of the State of Florida since ~L day of
, 19~y and 1 reside at ~0/ d'~~~A~ ~i _ 2 ~12
r (Street ~od Numbet)
~ . dT -l~~N - County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(insert Aere anr pertioent fac~s. sucA as sale ot pwpettr ar bosinas. or relinquishment ot empioymeat tt totmet
,,.~domiule, reinovai of family to new domicUe, purchase o[ home. etc.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school, ~
please list their names: ~
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ST.18C~~ C4:;!!TY ~ j
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2~549 '
I FURTHER CERTIFY that I wiil register at my local address when the registration books reopen, and
comply with all other requuements of a legal residerit of this State. .
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ ~~~rs ST. LUCIE County,
Florida, permanently. c~'tr) ~ - - ' ` ~
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~~~11{a~i~i~~,~~~ i
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Sworn•tq,~,d; ~be8. ore me this 1~ day of
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. -s3~ s ' 14.U. 19 74 _
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-;t=~.~ -o , Florida
ROGE ^ ~ _ jR[:iITT C~ 1RT
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gy r'r / Deputy Clerk :
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- 0 R ~;c,iV PA6E ~~a7lJ~ ~
a BOOK
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