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D~claratian ~f [~amic~~e and Ci~izer~~hip ~
'I'O Tll~ STA7'E ANU C'UUNTY 7'AX ASSI~SSOIt, ~~so ,
ST. LUCIC COUNTY, [~LORIDA: `
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Ti~is is my dcdaration of Domicilc and Citi-r.cnship in lhc~Statc of I~lorid.~ that 1 am tiling this day in 1
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accor~lancc, and in co~~formity ~yith Scctian 222.17, Florida Statutrs. 1
1 was fornierly a Icg.~i r~~~~i~nt or I~Av~ ~ ,_I~I~I IGI~I G A~11 and 1 ~
~c~~r) csu~c) :
rc~idcd at _~~~1__ ~~~~15~ . Howcvcr, 1 havc changcd my domicilc to ~
(Strret and Number) ~
and am and ha~~e bccn a bona tidr resident of the Statc ot i~lorida since 13 day of ~
, 19_~~, and 1 residc at ~ I`~ ~ T.
(Street and Number) ~
~e _ , _ St . Lucie _ County, Florida, ~
(cti~r) ~
~ind ihis statem~•nt is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
uf Florida.
(Inscrl 6ere any prrtincnt facls, such as salr uf pruperty or busiuess, or rcliaquishment of emplaymcnt at to~mrr ~
domicile, remu~~al u( tamily lti neN• Jom~rilc, purchase oi home, etc.)
Er~T~RI':G CHILDREH It1 SCHOOL: HOMESTEAD E?:EHiPTIOti: ~
If entering children in school, ~
please list their names: ~~~r~~~
F lE0 RK~ ~ECOROEO
' i~.IUC:E C~UNTY FIA.
~ RO"vEF a01tRA5 ~ -
ClEqK C'.:~CUIT COURT
FfC~a~ YEu'f~E~....~~-~
F~e 18 12 06 PH'75 ~
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~ 1 FUR7'}IF:R CERTIFY that I~viH rcgister at my local address when thc registration books reopen, and
~ comply with alf othcr reqniren:ents of a Icgal resident of this State.
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~ 1 rURTHER CL=RTIFY that 1 ha~•c no intcntion to return to my former domicile, and I intend to remain in '
~ _ ~ C ~ ST. LUCIE , Caunty, ~
~ Florida crmancntly. _
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" . ' ` _ --TS IGi~i~TURE -
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Syvorii ~Eo an ~b?~ribcd bcforc ~:~c this _ day of
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.~,~2c,`~ A. U. 19~~. '_.._'lo~ i ing ~t ~ re s s
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~ RUGER POiTRAS, CLERK CIRCUII' COURT ,~lorida
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~ IIy (~o~c-~i-~ Deputy Clerk ~
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~ (To be rxeruled in dupli: ate and oriEtioal tdrd w•ith ('lerk Circuit Court, anJ Juplicat~ ~~ilh Tax As~eswr)
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~ eooK ~36 ~+cE2641 ~ - -
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