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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~?~r
ST. LUCIL CpU~y, FLORIDA: .
This is my declaration of Domicilc ~nd Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with SeFtion 222.1?, Florida Statutcs.
~ 1 was formeriy a legal resident of ~ -~~~n~ _ , ° ' ~ ~ and I
caa~ ~ csa~~
resided at . However, I have changed my domicile to
($ae~t sed Nembu)
and am and have been a bona fide resident of the State of Florida s~nce - day of
, 19_L~..Z.., and I reside at ~ ~ ~ °
, (scnec..a.N.me.r)
~ ` St._ Lucie County, Florida,
(air) ~
and this statement is to be taken as my declaration of citizenship, actual iegal residence and domicile in the State
of Florida.
(It~t here snlr Dertineot tacts. sucA as sale of Drope~ty o~ busiaas. a«tinquishment ot emplormeat at iocma
dornicBe. ~emovsl ot tamllr co nsw domiciN. Purehass ot home. etc.)
• HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN SCHOOL. ~ .
If entering children in . school,
please list their names: - _ _
O IJ it 7 ~I /l.G.!/~~~FJ`I~GLI
.~i~r,~
~ '
- . LEO Ak~ RECORDEp~ ~
LUCrE COUNTr F~~,
R~G[R ROtTRA~
CI~RR Gt;;~UtT COUR~
i _ RF~;rQ~ YE~;••r~p
j ~ - '
~ Mor It ix os PM'l~
~ ~$847
I FURTHER CERTIFY that - I wiII 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
~ ~ ~D'~~~ , ST. LUCIE County,
Florida, permanently. «i~''~ : '
lV CY~linc -
- ucE
SIGNATU
Sworn to and subscnbed before me this ~ay of _
-,:,~i:~f,,,, ,a CGU C.
~(9~~ ` ~ , ~ - A.D. l9
. ti~~• U~ . ~ y ' " : g
ROGEf~-~~~AS~;`f,.`~ } CIRCUIT COURT ~ ~ , Florida
Y..: ~{-la~~j{.~~ ;s1j[] - ~ t.i.- - '
'~~w~"~1 ..Ysb~:.fe.~..~ ~ .
i }~9 ~ r .
.
gy ' Deputy Clerk _ .
: r~ { . - : ;,1 .
, / `G~'~;'~`
~ i~ ~ ~
i ,)n duplic~te aod ori6inal iJed wilA Clerk Ckcuit Court. ~nd duplicste wit6 Tu As~esso~)
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