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Declaration of Domicile and Cit~zenship =
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TO THE STATE AND COUNTY TAX ASSESSOR, ~9~~03
ST. LUCIE CpUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
~ccardanc~, ~Il~ iii ~iiiifUiffilL~i Wi~I'i ~~tian iti.~?, F~~:i~3s Siste~tes. - ~
erf a le 1 resident of ~ ~'r ~ ~~-S I/ t~ S and I ~
I was form y ga
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resided at ~-rb l 83 rt~ -s~ ~ e~~• However, I have changed my domicile to
' (Serest sad Numbe~)
and am and have been a bona fide resident of the State of Florida since ~ 9 ? day of
i( c--t~ 19__i T, and t reside at T ~-°~=~L.~LL~
~ j (Stntt and Numbet) .
, ~ St. Lucie County, Florida,
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(Ci~r) -
and this statement is to be taken as my declaration of citizenship, actual legai residence and domicile in the State
of Florida.
(Inse~t Aer~ ~ar perlinent tacts. such as sale of propertr ar business. or relinquisAment of employment at forma
domfcile. ~cmo~sl of familr to new domie~e, purcAase of home. ete.)
• - HOMESTEAD EXEMPTION: ~
ENTERING CHILISREN IN SCHADL. ~ .
If entering children_in schoo~, ~~-j -
please list their names: ,
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Sj,~UCtC C~ UNTY FlA•
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CI~Ak C~ ~'ty~; COURt
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
compty with all other requirements of a legal.resident of this State. ~
I FURTHE CERTIFY that I have no intention to return to my former domicile, and I intend to remain in_
J~, ~ ST . LUC IE , CountY,
Florida, permanently.
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SIGNATURE
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S~"~jg~~p~~sEribed before me t~is `s day of
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F? ,.y~v r.t'NQ,
: ~..~~fi A.D. 19 ~
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:P'4~'gA~" RK C RCUIT COURT , Flo.rfda
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~ ~ U .;~aputy Clerk ~ _
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(?o be e: ted in dupl:~ ~ir and nriRinal fYed with Clerk C&cuR Coutt. ~nd duplicate with Tax Asseatot)
Beu~c ~AI~E
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