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U~~E~ra~~on C~~~~icE.~ ant~ Ci~~zen~i~~p
y
'I~U'1'lIE S'fr1'T1: ANI) CUUN"I'Y 7'AX ASS{:SSUIt,
_ ST. _LUClE_ ~~UNTY, I~LORIVA:
7'hiti is my dcrlaration uf Uomicilc an~l Citircnshi~~ in thc Statc of rlorida that 1 am filing this day in
accor~lancc, and in contc~rmity with Scction "'2''.17, Plorida Statutcs.
I was formcrly a Ic~al residrnt of _~~~n .~k~ F S~ and 1
(c~~Y) (s~~~e)
r~sieicd at ____-~1 S~11!~__.~'fz!~~~Z' However, 1 ltave changcd my domicile to
(Strrrt auJ NumAcr) ~ !
and :~m and havc Ucrn a bona lidc residcnt ot tlic State of l~lorida since ~ _ day at'
, 1 and 1 residr at S/~Jf~~/~?~E'•f' DR• ~Oily~-
(S1~ce! and 1Vumbcr)
f 1
F'~C'~ St. Lucie _ County, Florida,
(('itY)
.ind lhis statcment is to t~r takrn as my dr~laration of citizcnship, ac;tual Irgal residence and domicile in the State
~~f flarida.
~1nscrl hen anY {~rtinrnt facts, xuch as sale of ptoprrly or business, or relinquishment uf employment at formet
dumicilc, temwal uf famil)' lu nc~v Jumicilr, purchas- of humc, rlc.)
Er1TERT"G C}~ILD~ET~1 ITZ SCEiO~L: HOMCSTL:All LXErfPT1_0":: ~
If entnri:ig cliildren in school, ~
please l~st the~r names; !
~ ~
S i
i!LEO AND RC~pRDEo ~ ~
ST. WCIE COUNTY fLA.
ROCER PO~TRAS ~
CIERK CI~+CU1t COURT
RE~QR~ YERl~IED
~ ,1u~ t~ 2 3o PM'75 .
~~s
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~ 1 F'UKTHt:R CI:RTIF~' !hat 1 will re~istcr at my local :~ddress when the registration books reopcn, and
€ co~z~ply with all othcr rcq!~ircntcnts of .i Ir~al msiclent c~f this Statc.
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~ I T'URTHE:R CERTIFY that 1 have no intcntion tu rcturn to my former domicile, and 1 intend to remain in
ST. LUCIE
$ - _ , County, ~
~ Flvrida, pcrmanently. (~'"r~
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~ Swf,r•µ~3;~ntl ~u ~Cfi. ~~icforr mc this da~. of
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~ - • i i:~g ress ,
~ ROG ~OITRAS L~Rn ~:CUTT COllRT ~
~ ~ ZOr1C~u
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~ ~iy _ ueputf Clerk '
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~ (To be r~ec d i:; , J;r:dc :uid ~.ri;:i~al filyd with l'Irrk l'ircuit Cnurl. anJ duplicalc wilh Taz Assessor)
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