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Deciaration of Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpUNTY, FLORIDA:
This is my declarati ~n of Uomicile and Citizenship in the State of Ftorida that I am Rling this day in
accordance, and in conformity with Section 222.1 Florida Statutes. .
I was formerly a legal resident of _1'_'! Ed~~~'d . s S and I .
(ac~) tsi.a)
resided at ~~Z ~~~L~~~ ~ • However, I have changed my domicila _ to
(Strs~t aad NumO~r) ~
and am and have been a bona fide resident of the State of Florida since . ~ day of
, 19Z~ and I reside at 9~~. ~~L-D /P~
S 7`~ ~rC
~ (Stntt aad Nwabec)
~ ~~.t y`' ST L!~ G St. Lucie County, Florida, -
. (c~~r)
and this siatement is to be taken as my deciaration of citizenship, actual legal residence and domicile in the State
of Florida. ~~T/~ ~ ~ ~,vR~H~9S~~ ~ ~L=-r -
(Ime~t hen any pertinent iscts. sud? as :ale ot propsrtr ar busineat. or ~slinQuishment ot ee~ptorment at former
~ do~aieW. reaioval of fae~ilr to new domic0t. purch~se ot Aome. ete.) .
L• -HOMESTEAD EXEMPTION:
ENTERING CHILDREN IN SCH00 . ~ _
If entering children in school, -
please list- their namnes s ~
- _ -
1LED Ati~, RE
~ AO~CE
PQiMAE ~
~ CIERI~ CittCWT C4~RT
; RFCdRD VEFIfIfO
i . -
; ~ Il~r u 3 oZPM'1~ ~
I ~ .
- 29~142
I FU~RTHER CERT[FY that I will 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 1 have no intention to return to my former domicile, and I intend to remain in
~/L~ .S~ ~ (/G/L-- ~ ST. LUCIE , County,
Florida, permanently. ~~"t''~
. 't,: ~
.:..'Peiin~,,~:
~ •~~~s~~:~..':.,.t`3...~!/ri; • • •
r • ..y~',,
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~ .+~s , j" i . ~.y~ ~ ~t=,
,
~ ` ri;A i~4 F c ir , ~ •S IGNATU^R/E~
' ~i~ ~t.j ~ ~1
iJ~ ` ~ s " • , i ~ -
Svab~i~~'~p~r~id,s~},bscn~}#~~:~fore me this ~ day of
3. . .ict~; - A.. t~t .~C t L~~'•. _ . . .
~ ~ ~ A.D. 19 74
------~e~.,~~~,t_ g r s
ROGER~~~~~R;AS, CIERK CIRCUIT COURT , FZorida
- ~
~
g Deputy Clerk , .
(?o ee xecuted in dupiieste sod originsl t'~ed with CIKk CircuR Coutt, and duplicate with Tsz Asraso~)
- ~ 8~2~~ ~ 2~4
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~i' A"k F.: ~~T~-'/' W5 ~ ~
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