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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpU~y, FLORIDA:
lhit is my declaration of Domicile and Cit~zensliip in the Statc of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of sT C~~ l Q" ~ , ~ and i
_ ' (a~r)
j
G ~ d ~,~'c ~v G~ y ~2 J ~ . However, I have changed my domicile to
. ' (StrNt a~d Nua~Oa)
~
and am and have been a bona fide resident of tl?e State of Florida since day of
~ ~~+v h , 19 and I r~ide at 3/~•D ~n/e L 4 N~
~ (Sq+~t • NwsMt)
r'T ~J~ l~ _ St . Lucie County, Florida,
(Ci~r)
and this statement is to be taken as my deciaration~ of citiz~nship, actual legal residence and domicile in the State
of Florida. ~ -
(la~rt Aere aar pertinent facts. wch as sal~ ot propertr or businas. ar relinquithment ot eo~plorm~et at tormer _
. dowic~e. ~noval ot hn~iir to new domieile. pu~c~ase ot Aome. stc.)
ENTERING CHILDREN IN SCHOOL: 1~ .HOMESTEAD EXEMPTION:
If entering children in schoo ,
please list their names:
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p
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- . 294963
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
' comply with atl 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,
~ . ~
Florida, petmanently. «i"~
, .
, - ~
. I . - ~SC/l /1~P / ~2 7
..,ti~,".,....,., . _ ~SIGNAI'ilRE - .
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~.~~~~•~~'~!1 ~ ~`>y~~'
fore me this ~ da of
Swoii~;~q•ari~ ;sutiscri~~'~ Y
i „ " 74
7 ~ ~ ~ ~ ~A
_ A.D. 19
RQC~;R±-f ~p0l~8id~; .~ERK CIRCUIT COURT g r Florida
.L.~ , nr;-tiY~
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~~r~^'~: :i:.•'~4.'
g ~ ~ ~ Deputy Clerk .
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(To be sxetuted in duplic~te sad wi`inal t~led wilh Clrrk CitcuM Court. ana duplic~te w~itA Ta: Aasessot)
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