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Deciaration of Do~niciis ant! Citizenship
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TO Tl1E STATC AND COUNTY TAX ASSESSOR.
290'793 }
_ ST. LUCTE _ CpV~y, FLORIUA: , ~
This is my dcc1:?ration ~f Domicilc and Citizcnship in thc State of Florida that I am filing this day in
accordaiticc, and in conformity with Section 222.17, Florida Statutcs.
/vIu t~,e t-. s~ L,~s-- and I
1 was formerly a legal resident of ~~~r~ - ~5,,~~
y~ v ~f ~ ' S~~ . However, I have changed my damicile to
resided at
(Stteet awd NumAer) . f /
and am and ha~e bccn a bona fide residcnt of thc State of Florida since day of
L' , 191 8I1(~ ~ iCSI(~C 8~ I$~ Q /~t/ ~ ri J~~-
(Street NuwEes)
~
f. ~ ~ . ,S~/ ! c i t _ County, Florida,
(cti~r)
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State
of Florida.
(Insctl here anY P~*tiaent txts, such at sale ot propertY a~~• a relinQuishmeat ot empbyment st tormer
domieie. remoral ot familr to ~ew domicile. Purchss~ ot home. etc.)
* * ~I S HOOL: HOMESTEAD EXEMPTION: ~ ~
E.dTERI.IG CHII.DREN I. C ~ ,
If entering children in school, ~
please list their names:
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~Q~ rEA1i~r~~
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290~93
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I FURTHER CERTIFY that i will register at my local address when the registration b~oks reopen, and
comply with all other requirements of a legal resident of this State.
1 FURTHER CERTtFY that I have no intention to return to my former do:nicile, and I intend to remain in
f,/)t Q c_ _ ST . LUC IE , County,
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Florida, permanently. «'`r~
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ta'" Florida
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gy Deputy Clerk
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