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D~ctarat~an of Dr~m~c~~~ and Cftiz~n~h~~ ;
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"I'O "1'lIG S"I~ATI: AnU CUUN7'Y '1'AX ASSI:SSOR,
_ ST. _LUCIF. CUUN7'Y, fLO1tlUA:
"Il~is is my dcclaration of Damicilc c~nd Citizcnsl~ip ,in thc Statc af l=lorida ihat 1 am tiling this day in
accorda~u:c. and in conformity with Scction 222.17, I~lorida Statutcs.
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1~vas farmerly a l~bal residcnt of -~~~U and 1 s
(c~~Y~ ~sa~~) i
resid~.d at ~ ~ Howevcr, 1 havc ch~nbcd my domicilc t~ ~
(Strtet and Number) ~
and am and have becn a bona fide resident ~f the State of ~lorida since day of ~
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- , 19_~, and 1 resid~: at ~ ~ _S1_~_L-~ ~~!°I//~'s' .--1S~ ~
~ Slrnet and Number) '
St. Lucie County, Flurida,
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(c~ir) -
and thi~ statcment is to bc taken as my declaration of citizrnship, actu~~l Irgal residcuce and domicile in the State
af Florida.
(Inscri here any prrlinent facts, such as sale of prupcrty ur bu~iness, or rrlinquist~ment of employment at formrr
dsimicile, rrmo~'al uf famih to ne~v domicil., purchax of hume, rtc.)
EPI'~CRT~':G CIiILDRE?1 I;1 SCNOOL: ~ HON(ESTEAD ~YE?~iPTIO?y:
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If entering children ii~ school,
ple~se list their names: -
~ ~Ct-v-e~ ~e--Q ~ a--u-~c/
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x.B-~t.i.G~GL - fILE~ ANO RECORpEp ~
~T ~UCIE COUNTI~ FLA, `
CIERK
CIttCU1T C URT ~
RECORD yfR;~lEO~~
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~ 1 FUR7'IIER CI:R'I'11=Y th.+t I~vill rcrister at my local address ~+~hcn the rc•~"stration books reopen, and
; comply with all uthrr req!iirements of a Iegal msident of lhis State.
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~ 1 ~URTIIGK CGRTII=Y t}~at 1 havc nc~ intc:ition to reti:rn to m~~ forn~cr domicile, and 1 intcnd to rcmain in
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~ ST. LUCI~
~ - - - - - ~ - , COUntY,
~ l~~uri , p~rmanrntl~~. lc~~>~
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= Sworn ~U.krrc.,~~w1~s`riUrd befc~rc mc this ____L~. day of '
~ _ r t ~ ~o:s ~ y~- n T
~ • / / ~ ~s ~~5~/fn~
; ~ A.I?. 19----•
w ~ . . ~t`~"- , ing ~ ress
: R~~1~=:~~ZiI.~I~I.i:RK CI CUIT COURT
~ . , ~ _ Floricla
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8~- ~ ; Deput}~ C1erY
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~ ,,.i(~ lie ex IeJ i~~ dupli< ~1r :roJ ari;:inal filyd wilh rlr~1. C~rcuit Courl, anJ duplicale Ni1h Tax Asxsaorl
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