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Declaration of Dar~nic~{e ~nd Citizer~~hip +
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'1'U Tfil: 51'ATE AND COUNTY TAX ASSI:SSOIt,
~ ST. LUCIF ~UUNTY, ~I.ORIUA:
Tl~is is my clcclarati~n of Domicilc and Citizenshi~~ in thc Statc of Florida thut 1 am liling this day in
accordancc, and in conformity witlt Scction 22?.17, Florida Statutrs. ~
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ec~iGt.~ • ~~tl 1 ~
1 was formcrly a lcgal nsident of ` ~ ,
(Cti~r) (Sta1e) j
residcd at . Howcvcr, I havc changcd my domicile to ~
(Street and Number) ~ ~
and am and have becn a bona fide resident of the State of Florida since ~ f day of :
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~ , 19- 6
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- and 1 residc at ~ ~'v ~ ~ ' ~c~y~.u-~ _ ~
(Stree nd Number) j
P~~ ~ Q..~_ _ , St . Lucie County, Flurida, #
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;.nd this st:~tcmcnt is to be taken as my declaration of citizenshi~~, actual lcgal residence and domicile in the State a
of Florida. ' ~
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(Insrri here any pertinent farts, such as s~1r oi p~operty or busincss, or reGnquishment of em{+loyment at formrr ;
domicile. removal uf family to ne~v domicilt, purchax of home, rtc.) '
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EfITERI;:G CNILDR~ti TN S~HOOI.: ~ ' HOI~ST~AD EXEMPTTON:
If etitering childreil in school,
please list their names:
3~~"j'2
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C~ERK CtRC~(!t ~p~RT-'~~
RECORO YEA~FIEO..,.~,~,~
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=R GRTIFY that l will n ister at m local addre~.t when thc re istration books reopen, and ~
IFURTHL C ~ Y R
ccn~ply with all otlier requiremcnts of a Iegal resident of tl~is State. , _
~ 1 FURTHER CEItTI~Y that I havc no intention to return to my fonner domicile, and I intcnd to rcmain in
~ _ST. LUCI~ _ , County,
~ FloriJa, pcnnanent{y. {~'~Y~ ~
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- J _ l. !l•, c - •
~ ` . - - ~ SALLY A DUNPHY
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~ ~ . , • i:, : S IGI~A'i'URE
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~ ~~~w:orn to and~sLtG~cribcd Uctorc mc this __y o uf
~ 'L' A.D. 19~.
_-_r=;--•-,,r.,;~-----~~ ~t ii~~ ress
~ ROGFR Pi)ITR~IS, CITRK CI?~CiIZT COURT . , Florid~
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~ ny ~v DepuCy Clerk- ~
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~ (To Le executed in duplicate and ori~in+l f~~~ CPA~~~~~N duplicalc «~Ih Tax Assesscu)
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