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D~claration of DonnR~ile arrd C~t~zensh~p
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'rU TtfE STATI: AND COUNTY TAX ASSL:SSUR, ~~~,~0
ST. LUCIE _COUNTY, FLORIUA:
'iliis is my cl~claration of Uomicilr and Citizcnship en thc State of Fiorida that I am filing Ihis d~y in
accordancc, and in conforniity with Si:ction 2'_'2.17, Florida Statutcs.
• j ~~t~:~\~ ~ \ti~aSS - and 1 ~
t was focmcrly a Irgal msidcnt of _ ~~r~ . ' 1
S,~~N ~~a~ . However, I have changed my domicile to
r~sided at _~.Q.~s.. ~s~reet s~d NumMer)
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and am and have b~.'en a bona fide rrsidcnt of the State of Florida since _ day of
~D Jac ~~ca~~c~a v ~
~ c fi , 19~ anci 1 reside at
(Street aad Numbcr)
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r ~~~Ce ~7~ ~ u County, Ftorida, ;
(city) '
and this statement is to be takcn as my declaration of citizenship, actual legal residence and damicile in the State
of Florida.
(Insett here aor {+ert~ocnt fxts, sucA ss sale of propettr or busiaess. ~x telinquishment ot emplorment at former
domicile, temoval uf tamily to nev~ domicile, purchase ot home, ete.j
E'1TERI"'G CHILDRE"j II~ SCHOOL: a NOMESTEAD EXEMPTI0~3: ~ ~
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If entering childre~s in school, ~
please list their names: -
g • ~e~~ ~
Af~~D YfRif~p~
A~ 1~ ~ ~2 =1~
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I FURTHER CERTIFY that 1 will register at my tocal address when the registration books reo~n, and
~omply with all other requirements ef a le~+l resident of this State.
1 FURTHER CERTIFIf that i have no intention to return to my former domicile, and 1 intend to remain in
ST. LUCIE , County,
~~r~ ~1~CC~
Florida, permanently. (~'~r~
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Swort~ to and su~isctibt~beCore me this ~~day of ~
r~~,' %~-.7G ~.I a r~ z z
~ ~ A. D. 19~~.
~ ' ~~t~~ ~ Florida
ROGER P ~e c rC ~ ~
gy ~~Cc Deputy Clerk
~ . BCOK~~ P11~E~~~
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