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Decl~rat~on of Dannicile and Citizen~~~~ E
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'1'U 7'lit: S'TATI: ANU COUN7'Y 1'AX ASSI:SSOR, i
ST. LUCIC ;
--_COUN7'Y, ~L.OItiDA:
71tis i~ my dccl.~ration of Domicilc and Cili7cnship in thc Statc of Florida lhat 1 am lilin~; this day in
accardai~cc, and in conformity with Scction 222.17, t=lorida Statutcs.
1 was farnicrly a Icgal resid.nt ot._ d/'~ ~,-----~.%'~~r_~/f ` and 1
~c~~r) (s~b~r)
residcd at 7.,? i s_1~~r'_trac-~
1~--11 . Howevcr, 1 hhvc changcd my domicile to
(Sttcet and Numbcr)
.ind am and havc bcrn a bona Cdc rosidcnt of thc Statc ~r r•~~aa since ~2T_~,~~'~'~'~day of' ~
, 19-----• and 1 nsidc at ~ ~P~~~~e?S ~5. ,
(Siteet and Number)
~ L f1.~ ~ _ _ , St . Lucie~ County, Fiorida,
(Cily)
~incl this statemr~~t is to br taken as my declaration of citizenship, actual kgal residence and domicile in the State
vf l~lorida.
(Inuri here any prrlin~nt factc, such as s.de uf ~~roprrty or busiuess, or relinyuishmr.it ot employment at totmer
domicile, remu+~al of family tu ne~v domicilr, purchn.e of home, rle.)
E;~'~LRI!!G C~~ILVRE~1 IN SCHOOL: HOMES'T~AD EXErIPTTO~~I: ~
If entering children i.n school,~
plelse list their names:
1~U;~.,v
~~L'1!L!
~~1.~_,~/,~~;1
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F~~{1~tALfiE
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ClER1C C~RCt11t ~
RECORD YERlF1E0 ~ ~
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~ 1 FUR7'HI:R Cl:RT1T'Y that 1 will re~ister at my local address ~~•hen the rcgistration boaks reopen, and
~ ~on~ply ~vith all othcr rcq!~ircmcnts of a Ic~:il resident of this Statc.
1 FURTNLR CI:RTII~Y that 1 havc no intention to return to m~~ former domicile, and I intend to remain in
" ST. LtTCIC C'ount
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~ I~IociJa, pcrmancntly. cc-'''`~
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i~ PUR~~Z
~ „'~p. ~ - ----S IGNATURE---------
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~ SK•grt~ to~ sub~~l~d~_ h~forc me this day of f Qc,.r ~f s~~~`s
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~ " `n ~-~'c~-~----- A_D. 19_~_? ~eS' ,~o~
- - • i i g ess
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~ ~~~'~t PU~~~S~ CLERK CIRCUIT COt1RT / , Florida
. ~"~'T~:".. ~t~2asn __(~,r~<!CY Gi.
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~ ~y ~ Deptit;? Clcr_k ~ .
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~ (To eaeculcd in Aui,lir.de and uri~inal f~IrJ ~vith ('letk ('irruit ('oint. aml Juplirato w•i1h Tax AssesscK) ~
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~ SOOK~?V!J PAGE1ci~ ~ ~
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