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Decl~ra~~~n of Donn~ci~~ and Ci~~~~nsi~~p
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7'O TI11: S1'ATL' ANU COUJ~7'Y ~'AX ASSL:SSOIt,
ST . LUC I C 3O~~s {
- - _ - COUNTY, 1~ LOltll)A: -
Tl~iti is n~y drelaration of Uomicilc and Citizcnshi~~ in th~ State of F7arida that 1 am filing this day in
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accor~lancc, and in conformity with Scction ~22.17, Florida Statutcs.
l w~is form~rly a Icga! residcnt of / O~~A~
E. 'l , N F~ o~ and I
lc~~~1f (sa !
r~a~~~«~ 2'~L__FENiMOR, E~v E. . Howcvcr, 1 have changcd my domicilc to
(Strcet and Numberj ~
an~ am and havc bccn a bona lidc rrsidcnt of thc State ol Florida since f- day of
--~q!PC f~ 19?~ and 1 residc at _ y76- .fiLGEa ~ ~fI•~JC~
(Strcet and Number)
~,Q ~T ~ uC/C St. Lucie County, Florida,
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(c~tr)
s~~d this stateme»t is to be takcn as my drelaration of citizenship, actual lega) residrnce and domicilc in the State
of rlorida.
(inxri here any prrlincM facis, such as salc of pruperty or business, or relinqui~i~mrnt of employrt:cnl at formet
domicile, remo~~al e~ f•rmily to ne~v domicile, putchase of home, rlc J
• 'I ~ ILDREr: IN SCHOOL: HO1~S'CrAD E~riPTTO~i: ~
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If entering children in school,
please list their names;
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F~~ j~ L011MT~( ~ ~4
St. ~ilL ;
RGGEF F 3~A1~9 aT ~ ~
' C~E~K ~~R^ CDy 4
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30~9~
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~ I l~URTIfI:R CERTIT'Y that 1 will re~ister at tny local address when the registration books reopcn, and
~ rom{~ly with all otl~~r req!iiremci~ts of a Ic~al residcnt of this Statc.
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~ I 1=URTHGR Cf:RTlf~Y that I havc no intcntion to rcturn to my formcr domicilc, and 1 intcnd to ret~~ain in
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a ~ - ST. LUCIE
_ ~ o ~ T S ! L c~ G i c~ - , County,
s{ }~IoriJa, pcrmancntly. (~'iy~ '
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SwtiY~i~~o'~nfl;,sut~.,~:rib~d bcfurc m~: this--~%- d.~y of
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; 1 1T}~' r re S S
" '.~~ZQGFP. PCZ~'L1R~S, CI~RK IRCiI1T CO'JR~C ~,eT S'~~vc,~ , I'loiida
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~ .'•$y~ ~ ~1 Dep~:ty Cl - ~k . ~ .
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`~i; ~ (To be eculed in dupla'at~ anJ uri~~n.~! . '•LiU~ C lrsk Cir~u~f ~'~url. a~id duplhalc wilh Tax Asxsvn)
x~:9 0 R~'7 PAGE 29~ ~
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