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Declaration of Domi~ile and Citiz~nship
"I U TlIE STATE ANU COUNTY 1'AX ASS~SSOR,
ST . I.UC IE • ~89~~4
_ _ _ COUNTY. FLURIDA:
Tliis is my dcclaration of Domicilc and Citizcn•hip in the Statc of Florida ihat I am tiling tl~is day in
accordancc. and in confurmity wilh Scctioiz 222.17, Florida Statutes. ~ ~
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1 was f~rmcrly a icgal resident.of y~ ~ and 1
(citY) ' . (St~te) ~
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resided at ya~~,T~brG.~ However, 1 have changed my domicile to
(St~ett ami Number)
and am and have bc~en a bona tide resident of the State of Florida since ~ ~ day of
4 ~2/ .2 ,v, F 5~~~
~C'a , 19~._., and I reside at ~ ~
(Street and [3umbet) ~
~Q~~ s~ L~,L~ , County, Florida,
(c~~r) ~
and this sta~+::nent is to taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(instri here any pertiaent fxts, such as sak ot p~opcrtr or Dusiness, o~ relinquishment of employment at former
domicile. temoral of tamilr to oew dumicile. purchase oi Aome, etc.) ~
ENTERING CHILDREN IN SCHOOL: HOMESTEAD E:~MPTION: ~
If entering chiZdren in school, -
please list their names:
_~~Ti('~"~ ~~vc~ (.~a57~~
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I FURTHER CERTIFY that I will register at my local addres~ 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 ijitention to return to my former domicile, and I intend to remain in ~
~
~ ~ ST . LUC IE County,
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Fforid , pennanently. (~"r)
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Sh~orn:t~nnd ~~scfit#ed before me this day of ' F
_ , . _ . ~ 3 ~~s-v i>
. ~ L ~y A.D. l 9_~_4__. ~ .
_ , ~ ` _ .'~4 ~ iIRT , Florida
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By , ~_Deputy Clerk : ~
BOOK ~J~ PAGi ~rri`~ . ~
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