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taration of Domicile and Citizenship
Dec
~ 2~ssss :
'I'O TtiE STATE ANU COUNTY TAX ASSGSSOR, .
ST. LUCIE CpUNTY, FLORIDA: ~ :
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71~is is my dcclaration of Domicilc and Citizenship in thc Statc of Flarida that 1 am fili~zg this day in
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accordance, and in conformity with Section 222.17, Florida Statutcs.
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1 was formerly a legai resident.of ~Q t~-~-G G~~iZC~ ` 1 and 1
(Citr) ' (state)
resided at ~ Nt ~ o~~~ ~-c- . However, 1 have changed my domicile to
(StPeet and Numbcr) ~ H
and am and have been a bona fide resident of the State of Florida since day of
S ~ N~ , 19~~, and I reside at 2~ ~ 5•~'`~ • t~ E'~ ~10~- aS A~c
_ (Stteet ~nd Number)
~o~ZT S.-. l._. J C. . ST L.~c County, Florida,
(a~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnsert here ~ny pertinent fxts, such as ule ot property or business, or relinquishment ot employmcnt at tormer
domicle. remowal of hmily to new domicJe. purchase of home. etc.)
ENTERING CHILDREN IN SCNOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in 5chool,
please list their names: :
,
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I FURTHER CERTIFY that I wiU register at my locai address when the registration books reopen, and
comply with all other requirements of a legal resident of this State. .
I FURTHER C~RTIFY that I have no intention to return to my former domicile, and I intend to remain in
~a ~ ~ 5
i - ~ < < ~ ST . LUC IE , County,
Florida, permanently.
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~ Swo~ 't,ti arid s~~i~bul before me this~- day of
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+~1' ;
~ A.D. 19 74
' ' t~ , Florida
~ _ R R~.~.. ~ _ T- ,
~ ny ~4'~~ Deputy Clerk ~
600K ~ PALE~~9~t .
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