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Deci~ratian o# DQr~icife ~nd Ci#izenship
T41'tifi STAT~ ANU COUNTY 1'AX ASSI:SSOR, ~J8
ST. LU~IE _ COUNTY, FLORiDA:
Tliis is my dcclaration of Domicilc and Citizenship in the State of Florida that 1 am filing this day in
accordancc, and i~i conformity with Section 222.17, Florida Statutes. ~
~
1 was formerly a(egal resident of l,~n 1~~~~ and 1
~ (Citr) (State)
resided at a ~ - . However, I have changed my domicile to
(saee~ a~~d N~me~r) ~
and am and have been a bona fide residcnt of the State of Florida since - day of
Ti~~•~~~.~3 , 19~ and I reside at
(Strcet iad NumOer)
~i-~~ Q~.¢~ c,~ , ~ County, Florida,
(air) " -
and this statement is to be taken as my declaration of citizenship, actua! legal residence and domicile in the State
of Florida.
(Insett Aete any pettiae~t facts. such u ssle ot prope~tlr or b~sinas. or reliaquisl+mrnt ot emplormeat ~t fwmer
dou~iei7e. remorai of familr to nevr d~micile. PurcAie ot hocee. etc.)
ENTERING ~HILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
I~ ~entering chi~ciren in schoo2,
please list heir name •
_ +
r = _ _
~ * .
f ~EO ANO Rf COR - ~ ~
i~ ~i1CiE C01lMTY
- ROCE~ F41TIt~ ,
CLEItK ClRCUIT COIIRT ~ ~
IIECORO YERlf1E~~..~i
~ ~ ~ ~ ~ ~ s8 ~'1~
~
~ ~os8
I FURTHER CERTIFY that I wil! register at my locat address wh•en the registration books reopen, and
comply with all other requirements ~f a legal resident of this State.
I FURTHER T1FY ihat I have no intention to return to my former domicile, and I intend to remain in
c~ ~ ST. LUCIE , County,
Florida, permanently.
- ~ ~ G"~c~ ' ~ _
. _
_~~.;;lila2;~,:.,~_•,
, \ 1' v~~ ~ _
\~ti • ~ ~;.T- .
~ ; - a _ ~O %
/YC P/~
- - ~ ;
- c ; ~ ~ :
s.~,:+ s_a:
"~or'ti~tci;~pd ~ before me this ~ day of .5~d~
i -.;~t~s• '~i~ .
• ~~a / ~ .
A.D. 19~~_
. T '~E,.~_~~cp.~,C~e~ , Florida
ROGER P DIIBT-
By Deputy Cierk
r~E EI~
i,~.,, ~
~ ~ ~ ; _ - - - - - - ~ ~
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