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Declaration of Domicile and Cit~izenship ~
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TU TIIL: S"fA'I'E ANU ('OUN7'Y TAX ASSL~.SSOR, ~'~s
ST. LUCIE _ ^T _ COUN'fY, TLORIUA:
Tl~is is my drelaration af Uomicilc and Citizcnship in thc Statc of F'lorida that 1 am tiling this day in
accordancc, and in conformity with Section 222.17, Florida Statutes. •
1 was fornicrly a Icgal residcnt of ~ and 1
tCi~r) ts ~ )
resided at ~~~Q~_~___~Q~_ . However, I have changed my domicile to. "
(Slrcel and Numlxr)
.~nd am and have bccn a lwna fidr resident of the State ot Florida since - $ day o1'
, 19~~~ and I residc at ~0~~~•
~~~~~~L. \V
(Slreet and Number)
'Q~ ~ (Z~,~ - St . Lucie County, Florida,
cc~~r)
~~nd this statcment is to be taken as my declaration of citizenship, act~~al legal residence and domicile in the State
of I~lorida. -
(Inurt hrre any pcrtineot facis, such as sale of pmperty or husinrss, or relinquisAment of employmeni al former
domicqe, removal of Iamily to rtew domicile, purchase uf home, clcJ
E~IT~RI*IG CHILDRE?~ IPd SCHOOL: HOMCSTEAD EXEMPTIO*l:
If entering children in school,
~lease list tlleir names:
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ROCER ?aiTR~i
GL~1tR tiF~Cnit p011R~ i '
RfCORO YERIf1E0~~""~
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= 302r006
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1 FURTHER CERTIFY that 1 will register at my local address ~vhen the registration books reopen, and
comply with ail othcr requirements ota legal msident of this State.
~ I FURTHLR CI:KTI~Y that I havc no intention to return to my former domicilc, and I intcnd to remain in .
~ ST. LUCIE
~ ~a Q ~-r _ Co~mty,
y~~i~-~-~.-._-- .o.e~. ,
~ 1=lorida, pennancntly.
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~ S~ernfn:to"and sub~rit~bcfore mc this-~~ day of .
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~ : ~~L~_±--~ A.L~. ~9__-~~ O~_ ~ .
'!~F i f~ ~~.I•.i:. ~-t:f.~\ -~a;. : ..:zg ress
~ R ~ r CLERIC CIRCUIT COURT I'lorida
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~ By Aeputy Clerk ,
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(To be eculed in dup1icale anJ oriFinal fil~•J wilh Clcrk Circuil Coutt. anJ duplicnte wilh Tax Ascesu~r)
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