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Deciaration of' Domicile and Citizenship '
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
ST. LUCIE Cp~TY, FI.ORIDA:
This is my declaration of Domlcile and Citizenship in the Statc of Florida that I am filing this day in
accordance, and In confornuty with Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of ~c- and I
tc~a) . lsua~ _
Q~~ ~,n c~~ ~~'L.- ~ . Hor~rever, 1 havc chang~d my domicilc to
residcd at
tsae.~ .4a NYmea)
~ and am and have been a~ bona fide resident of the State of Florida since day"of
\4~ ~ 1 ~11 ~ ~Q -Oti2(~- Rz~4,..s~4.
~c~~r~.lnah__ , _ 19~--.,_ and _I _reside at- - _ _ . ~
- j - .
_ _ _ (Str.st aaa Nunea) - - - -
~c~s-L.c~ ~~,s~L- , St . Lucie County, Flodda,.
~ntr~ .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Insert here aay pertineM txts. such as ssN of propertr or businas. o~ relin9uhfim~nt ot aaplorment s! totmet
domicW. remoral ot familr eo aew domicile. patd~ase ot home. ete.)
HOMESTEAD EXEMPTION: ~
ENTERING CHILDREN IN SCHOOL:
If entering children in school, . -
please list their nemes: '
F~EO AMG KECOiteEp
ET. tt{Cii CatINTY FlA.
' ROCEF: ?OtTRAS ~
~ CLERK CI:;;;~~T C4URT
~ ltECtfR~ 'vE*~~=~Ep
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and ~
comply with all other requirements of a tegal resident of this State. ~ ~ a
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
ST . LUCIE County,
s c~ c~ , ,
Florida, permanently. cci~r)
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SIGNATURE
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Swo~,t~~~~,~tb~cribed before me this ~ day of
~r_ , - ~"~~~5 \ 1
t~••~:~0 A.D. 19 74 aYo~au.~v
~~,YK~~~,. J r
~ '~~C~~I~ CLERK CIRCUIT COURT _ _ , Florida
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~ ~ Deputy Clerk • ~ ~ ~
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~:,r, O be eaec~ted in duplieale ~nd oriRinal fdcd wilA Clerk C~cuR Courl, and duplkale with T~x Assessor)
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