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Decla~~tEar~ of [~a~~~c~~~ and C,it~~~nst~?p ;
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~ro ~r~i~: srn~ri: n~u c~ovN~i~~ ~I~AX ASSI:SSUK, ~pi199
_ ST. LUCIr - ('U~1N'I~Y, 1~ LORII)A:
Tl~is is my drelaratic~n of I)omicilc ~~nd Citi•r.rn~hip in thc St:~tc of C=lorida that I am filing this day in ~
a~:cunlancr, and in conl'~rmity with Scction "'?~.17, Floricl~i Statutcs.
1 was fc~rmcrly a k~al rrsidci~t of .---_~~S'•t~NqC ,__~£4/~ t.P.r ~ and 1
(CitY~ (Slatt)
residcd :~t ~.~0~4_4?_ Howcvcr, t havc ch~nbed my domici:c ta
(Slrret anJ huinbe~)
and am and havc Ix~rn a boir~ fidc residcnt of the Stalc of Florida sincc day ot~ _
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---l~f~Z~ , 19_'~~, ancl 1 residc at ---~_~iX/~ _!~L~ /yCrrlf S,
~ (Street and Number)
~~c7~ £_~C ~ St . Lucie , County, Flurida,
(c'~tr)
~~nd this statemcnl is tc~ be taken as m~~ derl;,ration of ritir.enship, actual Ic~al residence and domicile in the State
~~f I~lori~la.
' (Insrr: he~e any pertin~nt factc, such as sal. ~d ~ruperty oc huxinrs~, or relinyuishment of employm~nt at formrr
Jomirik, rem~,~al uf lamily tu nrw dumirii.. purchax vf Lumr. rlr.)
I:r~T~1ZI;~G C~iILDRF.r; I?I SCNOOL: }iOMESTLAD E~TiPTIO''~;: ~
If entering children in school, ~
please list their names:
~R~ ~s 1, ~
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fILED AMD RECOROEQ ;
ST. LUCIE COUNTY FLA. _
IIOCeR POITRAE i
CLERK C{P.vUIT COURT u~ ;
AECOAO VERtFIEO i
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I I~L1R"TIIt;R CI:R7'lf=ti' that 1 will rr~ieter at my local aildmss whcn thr rcgistration Uooks rcopcn, and
~c~mply with aU ~thcr rrq!iirrmrnte of a legal resiJ~ nt of l~t:s St;itti.
~ 1 1=URTIII:R C1:RTIF=Y th:~t ! ha~~c no intr:~tion to return to my farmrr domi~ilc, and 1 intcnd to remain in
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~ ~--v~ ~rQ~ ~ - - - - • ST. LLCIC , Cuunty,
~ t~lorida, pc~man~~tiy.., ~r~"'>
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~]~?ed l~cf~~rr mc thi. _ day of
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~ 7
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~ ;ll i ng n~i'c.~re ~ s
F(}GC:i POITftf.S, CL.LltI: CIRCUTT COURT Floric:a
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~ y - ~ 1)eputy '?_crl:
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~ o be r'. , nlyd in du~~li. alc :~nJ un; in :1 ilh t't.rk ('ircuil ('ourl. anJ duplic~le ~tii~h 7 i* Ac.cseut)
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