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Declaration of Domicile ar~d Citizen5hip
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TO TIIE STATE AND CUUNTY TAX ASS~SSOR. ~~s
ST. LUCIE _ CpU~Y. FLORIUA: :
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'Il?is is my dcclar~tion of Domicilc and Citizcnship in 1h~ Statc of Florida that ! am Cling this day in .
acconlancc, and in confurniity wittl Section 222.1?. Florida Statutcs.
~ s' ~ ~ i O _ and I
1 was formcrly a legal resident of ~
r~sidcd at ~a~ ~~P'"n v Sfi~PP~ . Howcver, I havc changed my domicilc to
(Stt aad Numbtt)
de~/ 01
and am and have bccn a bona fide n~sident of the State of Florida since
~3 / , 19~~, and 1 reside at L 5• ~
- (Street ~ud Number)
r~ J~i~~~'C P S 7~- County, Florida,
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(City)
and this statement is to bc taken as my declaration of citizenship, actual lcgal residence and domicile in the State
of Florida.
(lase~t here anr pertinent fxts, suci~ as sak of propertr or pusiness. or rd~nquisAmeat ot emplo7rmept ~t fotmet .
' dowie~e, temoral of tamilr to new domicile, purchase ot home, etc.)
* DREN IN SCHOOL: NOMESTEAD EXEMPTION: ~
ENTERI.IG CHIL
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please list their names: ~
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I FURTHER CERTIFY that I wiU register at my iacal address when the registration books reopen, and ;
comply with all other requirements ef a legal resident of this State. ~
I FURTHER CERTIFY that 1 have no intention to return to my former domiciie, and I intend to remain in
F~ ~p.e,,,~ ~ ST. LUCIE , County,
Florida, permanently. ~~'`r~ ~ -
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~-$W~TI1"t0 Ub5CT1'tscd .~efore me this C~Z.- day o 3
o• y : , '
In .;~'~*~`r ,I A.D. 19~~ ~
.~~i~•~ ~ ~t=. ~ ~QC~~~~ - - - Florida
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g y~"'~~~r W Deputy Clerk
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. b~00RIt~.V~ PACE~~
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