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Deciarati~n of Domicile and C~tiiensh~p
"fU Ttl~ STATI: AN[) C:OUNTY TA~ ASSt:SSOR, ~~1
ST. LUCIE COUNTY, FLORIUA:
'Riis is my declar~tion of Domicilc and Citizcnship in the State of Florida that t am Gling this day in t
accordance, and in conformity with Section 2.17, Florida Stah~tes.
' and I
1 was fornierly a Iegal resid~nt of _ ~5~,~
resided ~:t _ . However, ! havc changed my domicile to ~
(Strcet an NumDe~)
_ day ol'
anci am and have bcen a bona fide nsident oC thc State of I~lorida since
a~id I residc at ~
, 19~~ ~ (5 1 and umbtt)
' St . Lucie County, Florida,
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and this statement is to be taken as my s~cclaration of citizcnship, actual legal rwidence and domicile in the State
of Florida.
(Inxrl here anY P«~~nrnt facts, such u sale of propcrty or business, or relinquishment of emplorment st fo~me~
domicJe, remoral of famil7 to new domicila, purchax of home, elc•) ~
ENTERING CHILDREN IN SCHOOL: HO?~STEAD EXEMFI'ION:
If enterin children in school, ~
g
plea e list their names:
. l ~
~~./f~~/~ /.~~~.c/~~, .
, -
s~~iu~
E couKn ~u~.
ROCER POITIIA=
CLERK CIRCUIT COWIT
. RECORp YfRIF~EO ~
- ~ Ara t1 9 3i ~i''7~ ~
~i
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' 290251 ~
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I FURTHER CERTIFY that I wiU register att of this Sta ea~~ When the registration books reopen, and '
comply with aq other requirements of a legal residen '
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ • ST . LUCIE County,
' i
, `tY, !
Florida, pe ently. ~
,
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t
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-
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' ' ' : C~ S IGNATURE
- _ . . . ~
Swoni to artd•su ~bed before me this ~~day of _ . ~
_ - ~ " 74 '
. 9 ~
• . - A.D. 19 ng r '
~ ~ . :
~-~p~~g,_~~p~ ~ CLERK C RCUIT COURT , , Florida
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r,• .,.,,,~a~' ~ -
By puty Clerk - - ~
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(Tp be e led in duplicate and otiginal filed r?ith Cletk CircuN Coutl, snd duplic~te with Taz Assessa) i
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