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Dec~«~ati~jn a~ Do~~~c~t~: anc3 Citizensi~ip
TO TI IC STA`fi: AND COUNTY '1'AX ASSGSSOR, ~ ~'~'s9
_ St .Lucie _ CpUN1'Y, FLORIDA: '
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'Il~is is my declarativn of Damicile and Citizenship in 1he State of Florida that 1 am filing this day in ~ ~
t
r.
acconlance, and in confonnity with Section 222.17, i~lorida Statutes. .
1 was fonncrly a legat re;sident of SO N ,-~'~~~~N~ and I
ic11Y) (State)
resided at ~g~?~ So~r.,i lc~nrv~~vs G?AY . However, 1 have changed my domicile to
. (Street snd Numbn)
and am and have becn a bona fide resident of the State of Florida since ~ F'~ST day of
now
ltilo ~/EMfjE~Q , 19
7~., and 1/~residc at 7 2 ~MMeoo~~ ~T, /~p ~ io z
(Street and N~mber)
~c T- P.F,PC E _ St . Luc ie County, Florida,
_ (c~tr)
and thi~ statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Imerl Aae anr pertinent. fxts, sueh u saie ot prope~er or business. or rdiaquishma+c ot emplorm~ut at t«mer
domic7e. removal of [amilr to ne~v dowiciie. purc6ase of home, ete.)
Entering children in~school;~ Homestead Exemption: -
t,
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- ST. ltiCrE Cp~Nj1r ~t~
CIEAK
Ct3~{~j~T OURT ~
; REC9R~ VfFrF~EO -f~
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E ~ ~ ~ 9 IO 39 ~~1,~ - 3.
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I FURTHER CERTIFY that I will register at my 1oca1 address when the registration books reopen, and
c~mpfy with all other requirements of a 1ega1 resident of this State. ~
I FURTHER CERTIFY that I have nv intention to return to_my former domicile, and I intend to remain in _
~,Q ~~,~c F St. Lucie County,
- ~
Floride, permanentl~. tcitr) ~ ` ~
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Signature husband) ° ' c ~
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`a~~~:~a~ai~.~. ~ J
.1~ ~C_^~_~tl~ Ql,1~~f~
~~'"~~y;~ ~'i nature wi~ ~
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'.~~_!_.~~'•..~~~~te I~T2. ~o/?1N1G~O~t CT; ~ flOz
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- '~o ai~t,t~= ~ s;c r beforc mc this day of ~~1Zing aadress '
;
`~s; A.U.19~-. ~-o.?T P.F.~Zc~ FL~4 33`~so
~ i?~ y - ? ~
'I~- ~ : ".:,.F ~a~r•w , ~ • .
. ~ S, CLERK CIRCUIT COL•RT
_ - ~
" - ~ . ~ _ $y _ - - -
- . Deputy C
(To be e~cculrJ in Jupli.:!Ic +nJ ur~,:~n.+ -d «ith ('Icrl. ('~rcuil ('ourl. an~~ Jupticale wtith Tax /lscr~ux)
~ ~~cK ~4 ~ 1067
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