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Declaration of Domicile and Citizenship
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'I~U THE STATE AND COUNTY TAX ASSl:SSOR~ ~
ST. LUCIE - ~5~ . ~
_ COUNTY, FLORlDA:
This is my declaration of Domicilc and Citizenship in the 5tate of Florida that 1 am filing this day in
accordance, and in coaformity with Section 222.17, Florida Statutes. ~
j ~e~aw~ort c and I
1 was fo~erly a legal residcnt of
a~r) ' (s~a.)
resided at ~ ~ ^ ~.~.t ~ t A"V @ However, I have changed my domicile to
csu~~ .~a N~~e~.~ t,~ -
and am and have been a bona fide resident of the State of Florida ~ since ~ day of
J~~ , 19~'~, and 1 reside at ~910~ ~R-s~'rt /~v e
(Street and Numbe~)
~ ~r. c P ~ County, Florida,
(a~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the S#ate
of Florida. ~
~ (Insert hae snr pertinent tscts. such as ssle of property or Dusiness, or relinquishment ot employmcnt at to~mer
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~ QOIII~CIIe~ ~tR10YO 01 ~aR1iq lU ~RN Y{l~~~RYV~ p"w....a.. .
ENTERING CHILDREN IN SCHOOL: HOMESTEAD EXEMPTION: a
If entering children in schQOl,
nlease list their names:
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Jo~w ~3. ~'1c. t`~a~?e ~ ' =
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I FU~tTHER CERTIFY that 1 will reeister at my local address when the registration books reopen, and
comply with all other requ'vements of a legal resident of this State. .
I FURTHER CERTIFY that I have no intention to return ta my former domicile, and 1 intend to remain in
~ ~ ~ ~ _ ST . LUCIE , County,
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Florida, permanently. (~~r)
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~wqFn~~ anc~~tl before me this J. day of
~ ;.~s. ~ ~ ; _ `f:. F - - A. D. 19~. ~
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,x ri~ ` - - - _ , Florida
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By ~Deputy Clerk ±
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. 6COK ~ ~N~ . ~
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