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;
i n of Dornicile and Citizenship ~
Deciarat a ~
;
E: AND COUNTY TAX ASSES50R, ~ •
TO TNE STAT ~"~s :
ST. LUCIE CpUN'1'Y~ ~LORlDA: '
This is my drel~ratic~n of Domicilc s~nd Citizcnship in thc Statc of Florida that 1 am filing this day in ~ i
~
accordancc, and in conforniity with Section 222.17, Florida Statutcs.
I was fomnerly a legal residcnt of ~?rt~ ~ e w - , Ma t s. and I
(Citr) (St~te)
residcd dt ~s N c ~ f. a-~t ` z . However, I have change.i my domicile to
(Strtet sod NumAet)
and am and have uecn a bona fide resident of the State of Florida since day of
5~r ,,f • , 19 and I reside at ~ow7~ ~ 3 ' 4wt'd°o ~ 2p i o?-i
.s
_ csuK~,oa Nome«)
"~"e r~ eN ~ eac ~ • L-~? c~ e County, Florida,
.
t~+~r)
and this statement is to be taken 3s my° declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(tusert here any pectinent ixts, such as uk of propertr or busineu. or relinquishment ot emplorment at fotma
' domicle. ~emo~al oi tamily to nevv domicile, purch ot home. etc.)
~ ~
ENTERIr?G CHILAREN IN SCHOOL: HOMESTEAD EXEMPTION:
If entering children in school, _
please list their names: -
"~1~ N 4.a~vo4Plfe, ~
~
t~UI:tE~CO~y~ i
RQQER P01T1G3 L
RECORp YERjF1E0
Str 11 8 a~ ~N'1~
~ -
29~.2'76
I FURTHFR CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
ST. LUCIE County,
-~-e r" s cn~ ~ c_
_a c. ti , '
Fl~:ida, permanently. cc~er)
_ ~9 d~-~x -
r. .1... ~,''%:,-~f _ .
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' ~ `ls..,,.. ?
: Fy~~ M~:.. J•: :~i t
;•.'r~,,;, , .
~ ~ ` " : - . , .
~ " ~ ~ day of ~
S~? to~nd subscri ~ee~'ore me this
-v'~ o i~d - ~ dooR o r-
'~~s `y r~ a'. y-.~~ ~ [1
~ ~ ~ .
r -^~`fl~' A.~. ~9 7~ -
• ~G s~N t~cQ~ t~ , Florida
ROG ~ - N
_ .,.~.y~~14 , . - -
gy . ~ Deputy Clerk •
' B00~lc ~vJ1 ~II~E~~
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