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. DeciaratiQn of D~miciie and Citiz~nship
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"1'U THC STATE AND CUUNTY TAX ASSGSSOR. 289~3~ ~
ST. LUCIC CpUNTY, FLORIDA: ~
'I7~is is my d~cla~alion of Domicile and Citi~cnship in the Statc of Florida that 1 am filing this day iz~ ~
,
arcor~+ance, and in confornuty with Section 222.17. Florida Statutes.
! was formerly a legal n~sident•of tv ~ w C`.~ _ , , ei ' and 1
(City) (Stste) .
resided at Sy . However, I have changed my domicile to ~
- (suK~ .Aa N~~e«~ _
and am and have been a bona fide resident of the State of Florida since '~~3 ~6 t sa ~
i~~s~~a-- , 19~ and ! residc at d S~ " 1
(s~~~.4a N~~e~)
~ ~ ~ ` c, ~ ~ _ S t_~, ~ , c._. _ County, Florida,
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and this statement is to be taken as my decla;ation of citizenship, actual legal residence and domicile in the State
of Florida.
(I~t Aete anr perl~nent fxts, such as sale of property or businus. or relinquist?ment of emplorment at formet
domic~le. removsl ot familr to new domicile. purchase of home, etc.)
ENTERING CHILDREN IN SCHOOL: ~ NOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names:
Q I c~ ~t- ~aS rier ~ '
,
fftEi= ~ yvis3E0 ~P • :
ST. lf3t! T' ~.Ni I C f U1. ~ E
f9~_r ':S~?,~S ~ ~ F
t~F~R i,: .:;L'iT "•OURi
QFr^' . . :r~
, - 1!~'[3 ~ Zg A~'7~ ~y
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, ~~s3s
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I FURTHER CERTIFY that I will register at my local address when the registration boaks reopen, and
comply ~?ith aU other requirements ef a legal resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
p~ p _ ST . LUC I~ County,
,
Fiotida, permanently. ~~'t''~ ~
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c.o~
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-'.Sa~pFn~to ar~su~elxd before me this day of
. - '~;t- A.D. l9 74 - ? ~
RbGEit ~P c'pitRT , Florida
gy ~ puty Clerk -
80QK ~~1 PAGE ~W , i
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, _ _ _ _ _ . . li F~~ . ,w'`
IE"r"S~ _1. ..l2' ..~r y 4 _ ~'~iF'~45~' ~,~~y,~~~~' .
_ ''4'. b_, r'•-_`cK~ i~ s~'i.. f .'~s~ T . _F . _.~`.._,`..:.,'a""~.~~°~,:':Yr"..' a.