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De~laration of Domicile and Citizenship
'i'O "t'tlE STA'I~C ANU C'UUN~'Y TAX ASSt:SSOR,
ST. LUCIE CO~JN1'Y, FLORIDA: ~89~~1 ~
Tl~is is my declaration of Domicilc and Citizcnship in thc Statc of Florida lhat l am fling this da~r in
accordancc, and in conforniity with Sectian 222.17, Florida Statutcs.
:
! was formerly a I~gal residcnt•of ~~.~A Gr e V~ and I ~
(City) (State)
residcd at ~1 • u~4 ~n a f'{- ~~~4 S~; n~" __S t s. . Nowever, 1 have changed my domicile to
(St~eet and Number)
and am and have been a bona fide resident of thc State of Florida since y day of
19~ and I reside at ~ 7 ~ e~Q a r c e.
' (s~~Ki.~a N~~e~.)
~ ~ . ~ j ,E ~ ~ E , S~, ~1 ~ ~ ~ County, Florida,
(cti~r) _
a~~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here awr pertinent facts, such as sale of ptopert7 ot Dusintss• or relinquishmeot oi empi.~rment at fotmer
domic~e~ rcmor~t of familr to oew domicile, purcAase of home, etc.)
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: a
If entering children in school,
~lease list their names: ~
;
ic ~iar J~ S ~l. 1-O Z ~L°
~
~e ~ r 7 , ~/o /C '
: . ~.-~xo
I sT.~v.~. ~ ~
; tnri_- -_,:-3~5 ~
f - _ :i.'uRT
~ a:r,r' +rl
!
a~~~ ~a u~A~~7a
~ss~s~. ~
~ I FURTHER CERTIFY that I will register at my lacal address when the registration books reopen, and i
comply with alf other requirements of a legal residerit of this State.
I FURTHER CERTI~Y that I have no intention to return to my former domicile, and I intend to rem~in in
~f . ~f
i e,^ ~ e ST . LUC IE , County,
~
Florida, permaneptly. ic'tr~
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Sv~ibi~, t~ artd•s~ 'bed befor~ me this~~ . day of -
A.D. 19 74 _ ~ ~
_
RC)GER~ P4ITRAS . CLE~K _CZ__RCUIZf~ ~T , rlarida
By ~ Deputy Clerk ` i
~
~ gooK~31 ~A~~ 1~5 . ; j
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