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' Domi~ile and ~itizenship '
De~clarati+~r~ of i ; ;
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TO TH1: STATE ANU COUNTY TAX ASS~SSOR, ;i t
ST. LUCIE _COUNTY, FLORIDA: t
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Tl~is is my drelaration of Domicilc and CitiTCnchip in thc Statc oi' Florida that I am Gling this day in
accordance, and in contorniity with Scction 222.17, Florida S:atutcs. ,
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1 was Cormcrly a Icgal resident of ~~~~~~7°~i •
(cur) (sac:~
~,~~~~eKTrt L CT , Howevcr, I have changed my domicile to ~
residcd at
(Sireet snd Number) r{ ~
an~ am and have been a bona Cde resident of the State of Ftorida since l~ day oi
~eca..,~,., 19 and 1 reside at ~Qob ~-a'`•
• ~ «~.~a N~~~~
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T ~ , ~ .5~7. L. ~~e County, Florida,
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and this statement is to be taken as my declaration of cilizenship, actual legal residence and domicile in the State
of Florida. ~
(Inseri hete anr pet~~neat facts, such as sale of p~operty or business, or rel:nquishment ot employment at iormer
' domicile, remoral of familr to oew domicJe, purchase of Aome, etc.) •
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E'1TERI"?G CHILDREN IN SCHOOL: ~ HOMESTEAD EX~MPTION: ~ ~
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If entering children in school,
please list their names: ~ -
QiE1t~ ~
AEQO~R91?ECI(iCWt~O~T i
RIPtEt.~
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I FURTf1ER CERTIFY that I wil! registcr at my local address when the registration books reopen, and
comply with aQ other requirements ~f a legal resident of this State. _
I FUR'fHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~T ST. LUCIE , County,
Florida, permanently. cc~~r)
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ji~t-to and subsc~il,te~.i~e[ore me this ~ day of -
! ~ J A.D. 19~~ ~
, F- ~r~-`' , Florida
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`Jf' •
gy ~ , ~i Deputy Clerk _
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