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Deciaration of Dar~zicil~ and Citiz~nship
~r~ •rt~i: s~rn~~~ nNU couN~~Y• ~'AX ASSt=.SSUIt, 3U?~15 -
ST. _LUCIE COUNTY,I~LOItInA:
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71iis is my drelaratian of Uomicilc and Citizcnship in thc State of l~lorida that 1 am fling this day in ~
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accorJancc, :~nd in confor~:~ity witl~ Section 222.17, Florida Statutcs. ~
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1 was fomicrly.a Icgal residcnt of
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r~sidcd at 9~U Howcver, I havc changcd my domicilc to !
(Strert anJ Numher) i
and am and havc Ixrn a bona fidc residcnt of thc Statc of ~lorid~ sincc a 4_ day of ~
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---~Q^'~~ , i 9~ 3, and I residc at :
• (Strect and Numtc:) ~
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_ A ,~',.,,t~,~,t,~,c.~, _ . St . Lucie County, Florida,
(a~~•) i
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and this statement is lo be taken as my declar.~lion of ci?izemhip, actual Icgal residence ancl domicile in thc State
of Florida.
(tnuri hert any ~•rttincnt facts, such as sal~ uf propcrty or Ausiness, or relinyuishment of employment at forme~
domicile, remo~a! uf (amily to new domicile, purchase ot home, clc.)
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ENTERT~G CHII.DREI~T IN SCHOOL: ~ HOMEST~AU EX~r4'T70'.'1: ~
If eiitering children in sctiool,
please list their names: ~~15
t1~0 RN?~ R Ooit o
T. `uC~~ CO ~Mrr ~EA. ~
IlOG~~ f4~711At
CLER~ ::~~CUIT COU~T ~
aECORt~ v[~+iiED
~e 28 9 09 A'I'75
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1 FURTIIL:R CEkTIFY that 1 will rc:~istcr at tny local address whcn thc rcgistration books reo~~cn, and ~
~ comply ~viU~ all otltcr requirem~nts ot~ a lr~al r~sident of this State. ~
~ I FURTHER CERTIFY that ( ha~c no intcntion to return to my fornier domicile, and I intcnd to remain in ~
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~ ~ ~ ST. LUCIE ~
~ rr.t v ,~...c~, , Counly,
Flori~la,.~crmancntly. <<''''~ ~
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~ . • _ ; ~ ~ ~ SIGNATliRIs---
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~ •S~yq~trCo• ~~ul~Scribcd beforc mc this day of
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`-~-~~.~~.2 A.D. 19.~~ a o g,~. 3 i~~~
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,ai in c~ress
~ ROGER PO1TRl~S, C1.ERK ~IRCUIT COUkT ~ Florida
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gy . ~,t~-- ~o~~-~c~ ,;`~,uty Clerk ,
~ (Tu bc executeJ ii~ ~nd o~i~;in:d fdcJ ~vi~h ('Ierk c'ircuif ('~~urt, anJ Juplirale Mi1h Tax Assessix)
aoac~ P~2567
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