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Declaration of DornECile and Citizenshrp
TO Tlif: STATG AND COUN1'Y TAX ASSESSOR, '~Q~~1
~ST.`LUCiE _ _ ~~uN~~Y, r~oKiuA:
Tl~is is my dcclaratiun of Domicilc an~l Citizenship in thc Statc of Flocida that 1 am filing this day in
accurdancc, and in conformity with Scction 2?2.17, Florida Statutcs.
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I was fonncrly a Icgai resident of ^ C~1~'~° ~ s/ 0 , vp • and 1
~c~~r) (s~.~e~
residcJ at ~ ~d • . Howevcr, 1 have changed my domicilc to
(5lrcet and Numbe~)
and am and l~avr ixcn a bona fide resident of .the State of Clorida since ~ day af
_ , 19 7 ~ , and I n:side at / ~d ~ ~E ST -~~i~.
~ ' (Slreet and Number)
rr __pi,~ ~ . St. Lucie County, Florida,
(c~~y)
•r.nd this siatement is to be t~iken as my declaration of citizenship, actuai legal nsidence and domicile in the State
of Florida.
(Insett hrre any perti~rnt facts, such u sale of prupcrty or business, or relinquishmeut of employment at former
domicl~, removal uf family to ncv~ domicilr, purchase of homc, etc.)
E':`~TCRI2~G CHILDRE?l IPJ SCHOOL: ~ HOMESTEAD EXEMPTIOiI:
If entering children in school, to"-1
please list thei_r names:
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fllE~ ANQ RECpRpEO `
3T. WCtE COUNTY fLA. ~
~ ROCER POITUAS - ~ ~
CI,ERK CiRCU1T COURT ;
RECORO YERIFIEO~` #
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- ~e 1+1 . 2 ii PN'75 , ~
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I FUKTHER CERTIFY that I will register at my loral address when th° registration books reopen, and
comply with al! othcr requiremenls of a lr~al resident of this Statc. ~
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1 FURTHE:R Cl;RTIrY that [ ha~•e i~o intci~tion to return to my fonner domicile, and 1 intend to remain in `
~ ~ P I~~ C~ ST . LUCI~ _ Count
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~ Florida, pcrmancntly.
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J~ • --SIGNATUR~ ~
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S~Vq~rt•Xa:` .'subsc~ ;~~~eforc mc this day of
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- • - ,~o ~ S~
~ --=r ' ' ~ A.D. 191.Z-_. U X
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in'I"~c~'-ress
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~ RO~~~I~~~ CI.EfiK CT1t~U1T COURT r~ p~~~ C~-~ ~ riorida
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~ II ~ I?^;~~~t}~ Clerk ~ y!
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~ , (To be ecut + duplicalc •iKinal filyd with Clerk l'ircuit Cburl, and duplia•ate wi~h Tax Assess~x) ~
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