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Dectaration o?f D~mi~ite and C~tii~n~hip
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':~U TtiF STATE ANU CUUNTY TAX ASSt=SSOR, iL~~~3~+ ' t
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ST. LUCIE CpUNTY, FLOIt1UA: `
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This is my declaration of Domicile and Citi7enship in 1he State of Ftorida that 1 am Gling this day in
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accorciance, and in confonnity with Section 222. 7, Florida Statutes.
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1 was formerly a Icgal reside~it•of ~
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residcd at ~ wJ v~`J ` . However, I have changed my domicile to
(Street and Numbe~)
and am and have been a bona fide resident of the State of Florida since day of
(i(.- l, 19 ~TI and I reside at ~d~ ~
(Strat aaA N ber)
e ? ~ , L-~ 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 F!orida. ~
(Iosert herc anY D~rtineat fxts, such u sale of propertr or Lusintss, or relinqu'~shment ot employment st tormet
domicHe, remowal of tamilr to new domicile, purchase ot home, etc.)
EN RIPIG CHILDREN IN SCHOOL: Q HUMESTEAD EXEMPTION: ~ _
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If entering children in school, ,
~lease list their names: '
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I FURTHER CERTIFY that I wil! re~ister at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intent'son to return to my former domicile, and I intend to remain in
~T p~t~`C ~ ~ ST. LUCIE , County,
Ftoreda, permanently. (~'tr)
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S~+vo~ jo and.sub~ci~cd ~efore me this _ day of r /
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~P~~ , A.D. 19~~__ ' ~
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_ R~GER P 7~RAS,.. CLERK _~IB~tJZT_ •~b[1gT , Florida
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By L 4<-f~ C~''~z I)eputy Clerk
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