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~ Dectaration of Domicile and Citizenship
TO THC STATC ANQ COUNTY TAX ASSCSSOR,
ST. LUCIE _ CpUNTY, FLORIDA: ~~73iZi
This is my declaration ~of Domicile and Citizenship in thc $tatc of Florida that I am filing this day in
~ accordance, and in conformity with Scction 222, t 7, Florida Statutes. ~
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1 was formerly a let;al resident of r[-» ~ , 21 and I
(Citr) ' • (State)
resided at . ~ e g ~Rs..~~~'! ~ Y P• . However, t have chan~ced my domicile to
(St~eet and NumEer) _
and am and have becn a bon~a fide resident of the State of Florida since ~ t6 day of
~rv'h~, 19_~ and 1 residc at -Q~ ~ ~Q. ~ _ ~el, .~'a
~ / . ~ (Street and Number)
' T, ,,c~e.c, St . Lucie
- ~ . County, Florida,
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and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State
of Florida. `
(lRSert here any pectloe~t tacts, such u sale ot property or busineu, or telinQuishmeat of employment ~t fermer
. domie~e. cemoval ot fsmily to new domicile. purchase ot home, ete.)
ENTERING CHII.DREN IN SCHOOL: _ HOMESTEAD. EXEMPTION: ~
If entering children in school, ~
please list their names:_
f LED AND l~fCORDEO `
` i~. L13CIE COUNTY FL~. J
. R05"== ~~31TRAS
ClEltR C~'s~tiiT COURT
~ aECn,t~1 rc: ~ Ff~EO
Doc 6 4 oi PN'~~I "
! . 296732
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1 FURTHER CERTiFY that 1 will register at my local address when the registration books reopen, and
compiy with all other requirements of a legal msident ot' this State. '
I FURTHER CERTIFY that T have no intcntion to return to my former domicile, and I intend to remain in
ST. LUCIE _ County,
,
Florida, permanently.
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~ ~:i';'•':'-~,M~'•~.~~.`•~~~- SIGN TURE
'%y`r,.~~ ri g : ~ -
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~Svvoi,~rt=~ ~aubs~~e~ before me this day of -
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~ ' r X ~ c. ~ ~ = 74 _ ~ 7- ,S 2~
' ~ t ~ A.D. 19_ ~Qc~}~ . o S
~ ~4;7.. ~ "~iZ~ng ~tc?'dr~s~"
S, CLE CIRCUIT COURT u~ , Florida
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By Deputy Cler_k ~
(Tu b~ uuteJ in dupiicate and oriRi~al filed rrith Cletk Cktuit Coutt, and duplicste with T~a Au:uck)
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