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Dectaration of Domicile and Citizenship i
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TO THE STATE AND COUN7'Y TAX ASS~SSOR,
ST. LUCIE COUNTY, F1.ORluA: -
'[l~is is my dcclaration of Domicilc and Citizenship in the Statc of Florida that I am fiting ihis day in
accordancc, and in canfotmity with Scction 222.17, Florida Statutes.
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I was formerly a legal resident of ~~~~°~U' ~ ~U and 1
~..,r.,~ (Citr) (stste) .
resided at S~~~1°
~-`7~ ST . Howevcr, I have changed my domicilc to
~..+..r. (Sueet snd Numbe~)
and ain and have been a bona fidc residcnt of thc State oC Florida since day of
iT//~!~ , 19 ~ and I icside at ~ ~ ~
i~ " " (Suee ~ad Number)
~o ~T ~
J~~ ~ St . LuC ie - County, Florida,
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and this statement is to be taken as my declaration of citiaenship, actual legal residence and domicile in the State
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(Insert here any pertinent tatts, such u sak of property or businas, or telinquishment of emploYment at [orme~
domic0e. removal of family to new domicJe, purchase of home. ete.)
~ • HOMESTEAD EX~rfPTIOIV: . ~
ENTERING CHILDREN IN SCHOCL. ~ _
If entering children in school,
please list their names:
J'~i ~E'.c.°Gf
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c+~ cos~i~'~~~.
R9~CE~ ~OITRAf ~
' _ RE `ORO VEP, FiEp ~~U~~ ~
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1 FURTHER CERTIFY that I will rcgister at my local address when the registration books reopen, and
camply with all other requirements of' a Iegal resident of this State.
I RTHER CERTIFY that I ha~~e no intention to return to my former domicile, and 1 intcnd to remain in
~ ST. LUCIE . County,
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Florida, permanently. cc~e>>
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- - " ~ ~ ~ -TS IGI~ATURE
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J : d Uefore me this day of
~ 74 c.~.D ,~il~~~lic~l/~
' ~~~o~: l A.D. 19 ~
" _ f _ ~ .ai in ress
' : ~ ' ~LE RK CI RCU IT COUItT `S~
A,,. ~ , Florida
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-~.~`;-~e~'' .,,~`L:.
; " Deputy Clerr - .
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~:>.=•;f.' s_ . ('fo be executed in dupiic~te and uri6inal fded wi~A ('lerk CbcuH Court, ~nd duplicale with 7~x Assescot)
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