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7'O 1'!IL• STATI: ANU COUN1'Y TA~ ASSI:SSOIt. ~1~08 . .
ST. L'JCIC _(;pUNTY; rLOR1DA: ~ ~
Tl~is is my dccf~r:ition of Domicilc ~nd Citizci~sltip in U~e State of Florida that I au~ filing this clay in
accordancc, and in conformity witl~ Scction 222.17, Florida Statutcs. • ~ ,
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1 was Corn~crly a Icgal residcnt oi'
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resided at • ' Ho~vever, I l~ave changed my domicile to
(stre ~a Nu r) -
and n~ and hav~ bccn a bona fidc residcnt of the St~tc of Clorida sincc day of
•~Q~_~9_1'-~., ~ and I residc at ~ O
(Stteet ~ um~et)
ST LUCIE County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of rlorida. ~ ' _
(Insett here anr De~tinent faets, such ss sale o( properlr or business. or telinquishment oi cmploymcnl at tormer
domic~q, ~emoval ot family to new domicile. pu~chase ot home. ett.)
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. Applying for homestead : . . - ~ ~
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. - Entering children in sc.iool . ?
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~ Other: ~ . . _ - .
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I FURTHGR CERTIFY that T will registcr at my local a~dress when the registration books rcopen, and
comply ~vith all otlicr sec~uirements of a legat resident of this State.
I FURTHL'• R CERTIFY that I liave no intention to return to my former domicilc, anci 1 intcnd to remain in
f ~ St~. Lucie , County, .
,
Fforida, permancntly. .
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: ~ ~~tt i~ c~ribGd Ucforc mc tliis ___L- day of . _
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ltOGEIt 1'Oi'1'1:RS, CL1:ltK C71t UI f COU1tT p R~~~~~ .
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