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Dec~aration of D~omic~0e and Cstizen5h~p ~
~I'O'1'ilt: STATI? ANU COUNTY TAX ASSE'sSSUR,
ST. LUCIE _!___COUNTY, rLOR1UA: a~O~OS
Tl~is is my dcclaration of Dotnicilc and Gitizenship in thc State of Florida that 1 am ~ling this day in
accordancc, and in conformity with SCction 222. t Florida Statutrs.
I was tormerly a legal resident of wQ eoNh ~ and 1
tci~r) ~sa~~~ -
resided at Ma~~ana( ~ . liowever, I have changed my domicile to
(Street and Numbcr)
and ant nd. havc tx:c~n a bona fide resident of the State of rlorida since I 9 day of
Fe~' , 19~~, and l residc at gg0 $w .~v~'~ ~O ~
~ (Street ~nd Number)
_~~L S%
• L~ e~`Q St . Lucie County, Flarida,
(cier)
;+nd this st:~tement is to be taken as my declaraiion of citizensl~ip, actual legal residence and domicile in the State
of Elorida.
(Inseri here any ~.ertinent f~cts, such u saie of property or business, or rrlinyuishment of employment at formet
domicle, removal of family to ne~v domicile, putchase of home, ete_)
Er]TERING CHILUREN IN SCHOOL: ~ HOMESTEAD EKEriPTIO'~~: ~
If enter~ng children in school, ? ~
please list their n~mes;
r~a ~2Q ~c~ 6- l~ f ti _
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itoc~A ~a~t~us 1~
CIERK L:RCUIT COlIRt C
RfCORD YEPtf1f0 \
' FE8 Z~I IO 39 IW'7~J
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~ I FURTHER CERTIFY that I will rcgister at my local address wl~en thc registration books reopen, and
~ comply witli all other requircments of a legal resident of tliis Statc.
~ I FUR"fHL'•R CERTIFY that I have no intention to return to my fom~er domicile, and I intend to remain in
~ ~o~/ S'~
. C li e~~~~ , ST. LUCIE , CountY,
~
~ Florida, perr~ancntly.
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~ ~Si~•t~};s~~e~~icd beforc nm tliis ~L day of
~ =i:, . r T
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~ A.U. 19~~
~ ~ ng ress
~ R(1GER POITRAS, CIERK CIRCUIT COURT , Flor.ida
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~ gy`~_ ~ Aeputy Clerk , ~
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(To eatcuteJ in duplicate and ertigin~l fdrd wilh (9r~k Circuit Court, and duplk•a1e wilh Tax Assessor)
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