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Declaratia~ of Dorn~c~4e and C~t~~ensh~p
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'I'U 7'l1E STATL ANU l'-OUNTY TAX ASSl:SSOR,
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ST. LUCIE _ GpUNTY, FI.ORIDA: ;
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This is my dcclaration oC Domicilc and Ci!izcnship in thc Statc ol Flarida that 1 am t'iling ihis day in
accordance, and in conformity with Section 222.17, Florida Statutes. ~
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I was formerly a Iegal resident.of ~~~~J f~•" ~ , and I ,
(Citr) tste) i
~ ~ . Howcver, I have changed my domicile to x
resicied at
(Str t snd Numbet) `~1'/~-'
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and am ar.d have been a bona fide resident csf the State of Florida since ~
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, 19~~, and I reside at ~ ~
, (S ad Numbet)
Cou»ty, Florida,
(a~r) ;
and this statement is to be taken as my declaration of citizenship, actual legal residence and damicile in the State
of Florida. -
(lase~t here aoy pertinent fscts. sueh u sale of propertr ot business. or relinquishmeot oi emplorment at formet
domicle. remoral of family to new domicile, purchase of Dome. ete.)
HILDREN IN SCHOOL: HOMESTEAU EXEMPTION:
ENTERING C
If entering children in school,
please list their names: :
C~ !1 (7~Pn 1C iC/la /~~So ~ - 1 :
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Ftt:~ ~i~ ;E€2RpEp _ ~ ~
ST. LU~;i ;,;~ti1lrY FLA•
FCv_ ::3;iP.~b
CtE~:A ..u~t C~UBT
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I FURTHER CERTIFY that I wil{ register at my~ local address when the registration books reopen, and
comply with aU other requirements of a legal resident of this State. .
I FURTHER CERTiFY that I have no entention to return to my former domicile, and I intend to remair in
~ ST. LUCIE County,
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Fiorida, permanently. (!,itr) ~
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:S~irorn-to and,s~u~~lbefore me this ~--L day of ~f ~
~ r: ~ A. D. 19 Z~---
~ - , Florida
ROGER, 1.~BK_CI.g~U1.T-~IIIIRT-- n
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~~~1-~~ ~a-~~
gy ~ Deputy Clerk
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