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Declaration of Domi~ile and Citi~enship
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"1'O TNC STATL' ANU COUNTY TAX ASSI=SSOR, i~rB~SS'. {
ST. LUCIE _ CpUNTY, FLORIDA: }
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This is my drelaration of Qomicilc and Citizensliip in the Statc of Florida that 1 am fling this day in ~
accorctanc~, and in cunforn~ity with Section 222.17, Florida Statutes. ~ ~
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1 was Pormerly a iegal resident~of ~p~ ~ , and I
(Cilr) (Stste) ~
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resided at ld~t~1,~. . However, I have changed my domicile to
(St~eet and Number)
and am ana have bcen a bona fide resident of the State of Florida since day of
, 19~~, and I reside at ~ ~ ~ ~ t
` ~ • _ (S res[~ Number)
t/
o
J~`' O?~Lt County, Florida,
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and this statement is to be taken as my declaration of citizenship, actuat legal residence and dom~cile in the State
of Florida. ~ ~
(Insert here any pertinent fxts, such as sak of property or business, or reliaquisAment ot employment at tormet
domicik. remoral ot hmilr to new domicJe, purchase ot home, etc_)
ENTERING CHILDREN IN SCHOOL: II. HOMESTEAD EXEMPTION: a
If entering children in school, ~
please list their names:
289 ~
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SL LUC ~ .;?{;NTY F~l
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I FURTHER CERTIFY that I wi~l regis±er at my local address when the r~gistration books reopen, and ~
~omply with all other requirements of a legal resident of this State.
I FURTHER CEP.'TIFY that I have no intention to return to my former domicile, and I irtend to remain in
ST. LUCIE i
~d~+ p , , County,
~lorida, permanently. (~'trf
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•-(Y~~ 'I., 's ~ ~
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Swdrn,to ~ndsu~~rfibed betore me this ~ day of ~
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A.D. 19~4
,
ROGER P ITRAS~ CLEIZK CIRCUIT CO[1~ , Florida
8~~~ ~c~,cl~ ~ Deputy Clerk "
Bt10K ~~1 PAGE _ ' ;
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