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Deciaration of Dom~c~le and Citi e s p
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpU~y, FLORIDA: ~
This ~s my declaration of Oomicilc and Citizenship in the Siate of Florida that t am filing this day In ~
acoordance, and in conformity with Scction 222.17, Ftorida Statutcs.
1 wss fo~e~y a legal resident af , Ne~ ~a~ and I .
resided at 137 Conklin Avenue . However, I have chan~ed my domicile to
~sa..e.a+ Nr,.e.~) . ~ .
and am _ and have been a bona fide resident of the. State of Florida since ~ day of
No~ember , 19
~
4 and 1 reside at 14 Lake Manor Park .
(8tr~t sad N~~Mt~ -
Eden S t. Luc ie County, Florida,
- cah~ .
and this statement is to be taken as my declaration of citizenship, actual tegal residence and domicile in the State
Florisl~. ~ - - _ .
" pw.~t aue anr recw~snt ruts. such a s~ie ot prope~tr cr bus~nes~. or-e~i~uis~e.c ot.mqorrn.~t a,to~m.~
8oaiefle, reaoval ot isailr to aew daakile. Purdas~ ot Somt. ~te.) - .
ppL; . HOMESTEAD EXEMPTION: ~
ENTERING CHILDREN IN SCH ~ _
If entering children in school, _ _
please list their names: . -
~ NONS - -
.
' _ fiiED At10 kECORDEp
~L LUC1E COUNTY FLA.
' . ROCE~ FO!TRAS
` ClfitK C:RCUITCOURT
~ REC~R;~ vr-:~rsEt1 '
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f I~C S II 12 A~'I'1~1
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I FURTHER CERTIFY that I will register at my loca! address when the registration books reopen, and _
' comply with all other requirements of a tegal resident of this State. ~
I FURTHER CERTIFY that I hare no intention to returs~ to my former domicile, and I intend to temain in
~ n ~ ST . LUCIE ~ - , County,
Florida, permanendy. c~`r)
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~~~~~it, f'~,
~ S IGNATtIRE
`~i lir.~~l'-3.t`:,'-~...
~tir~~~N~~~j siiY'q' .
$wd 3i~'~~~ .%f i~efore me this ~5.~ day of
: r; ,_'A' ~.4 Lake Manor Park
5:~, A.D. 19 74 p
' ~ ~ . :i~'t . . r = i . r ,
' ~ ~ ' ' ; :~~_~~.ERR IRCUIT COURT Jensen Beach , Florida ~
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gy t~ Deputy Clerk
(To M ~ted in duplic~~e ~nd wi~inal filed with Ckrk Circui/ Court. and duplic~t~ with Tu A~sessar)
~234 ~ 873 ~
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