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Deciaration of Dornicile and ~:t~z~ns p
.
TO 7'IIG STATE ANU COUNTY TAX ASSI;SSOR, 2~~,r3
ST. LUCIE _COUNTY. FLORIUA:
This is my dcclaration of Domiciic and Citi7cns!~ip in the Statc of
Florida that 1 am filing this day in
17 }=lorida Statutc~s.
accordancc, and in conformity with Sc..tion ,
• ~ ~z o c ~ sti ~ y~on and I
1 was formerly a legal resident of _ ~~~r ' ~sa,~~ -
. ~,{,(~S!?b~ 4/ l~ ~~'e~ However, 1 havs changed my domicile to
residcd at s~0 ~
(Strtet and Number)
day of
and am and have tx.'cn a bona fid~ residcnt of the State of Florida since
, 191.~, and I reside at /l~ ~-~l~~in~! Lane ~-src en c e ~s -
_ (Sucet snd Number)
F ~ ~t r ~ ~ . ~ County, Florida,
- ~cti~r)
ar~d this statement is to be taken as my declaration ot citizer.shi~, actual lrgal residence and domicile in the State
of Florida.
(Insc~i 1~_:e any prrlinent facts, such u sale of property or ~usiness, or relioquishment of emploY~u~~~ fotmer
domicile, remo~al u: (amily to nrw domiciie, purcAasr ot home, etc.)
~ '
E'VTERI"?G CHILDREN IN SCNOOL: ~ NOMESTEAD EXCMPTION: ~
~
If entering children in school,
please list their names:
~ ' ~2,~.
~~~~~f ~
~occ~ : o,TR~f ? ~
, R~~4st' YfR
f
Ed C~~
Ar~ ~6 2 s9 PN'~~1
' -
2~9fl353
I FURTHER CERTIFY that 1 will registcr at my local address when the registration books reopen, and
comply with all other requirements ~f a legal resideht of this State.
I FURTHER CERTIFY that I havc no intention to return to my former domicile, and I intend to remain in
~ ~ ~\~L ~~1 ST. LUCIE , County,
Florida, permanently. ~
; ~
i` L
_ / A /~L`P r~ Z~C~ /~'J~
- - ~
~ ' I~" ~ ~ da of '
Swor~ ~,o and su~urib~d~before me this Y ~ ~r ~ J ~3
' : ~ r- 7 ` ~ - A.D. 19 74 - ~ CJ -
" - . ;,,s: ~~7 ~.~t r_~ ~ Florida
R - nt~
• ~ /
gy ( ~ CL Deputy Clerk
~
- BO~K~~
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