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ST. ttlC~ C~Il'Y. FLA....
Dectarotion of Domicile and ~ Citizenship
TO TIIE STATE AND COUNTY TAB A88S88OR,
3T. LTJCIS COiJNJrY. FLO]RID~:
This is my declaration ~ Domiaik and CltissashlD in the State of 1~'lorlda that I am lllins this day in
accordance, and in conformity with Chapter 222, Section 222.1?, Florida 8tatntes.
I was formerly a 1e2a1 resident of_ w__.-_____._----_-__ ____ __~______~
(Clb) (i~sa)
.~~~ o
e«a i .e.iwai pt ~.i ~ u~v !'ltrr!'t!n°!'~ 7)"~'$ .sA~w£eei L+'IY dnw!
(8itwt sad Nassba)
to and am and 'cave been a bona >!~e resident of the State of Florida aince_-___---__ 2Uth___________________tu,y ;,;
-----------Decesaber____-__-__.-, 1~0`, and I reside at___-- 240 3,_ Ind_~a~~i•er_D~i!4----__-_--
(et~..t .aa xt,~)
Fort Pierce ~ 3t. Ltto~.e __County. Florida,
---------_ -~_ (cis)
and thin statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(Insert bare ~ partinaat gets. such as sslopsrtt ~ ~ o~r~liapnlsbmatt at oanploymsat st
torssa7 domkilo. ramo~al of tamil~ to now pnrebasa ,
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..,, ~ n t~ ~!~', RECOR~~ED
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..- Z ppiTRAS. CL- `.;~
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,. tUC1E COUTIj 1. F tp r~,
T FL1RZ'FtFR rERTIFY ±hAt I will register at my lxal address when the registration hooka reopen.
~ ~-- •a~. _~~ •1. "^'T3~'It3 .Zi i- la 231 wi.iw«• ..I o~ ~iw QN~a
uuu wt;i}-iy 'riwi wu OiuEY S'dj2::~. . $ :Y.13\a{r.ai ...
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
Fort Pierce 3t. Lucie _____________~_~ty, Florida,
permanently.
. ;, .
Sworn t0 ~, ~~11T
~, 1 ,
C
---- _~~_
r : . - -Patine a
My ~~~.
(To
(cit,)
h8fore m@ thla_-~------day of
~, A. D. 19 bl_.
~ rlosida at I.rt~
~~~ - - - -
-------- (Nasaa)
Eva Whiteman
(Addraas)
dnpliatta and original Alad wkh Clark Circuit Court, cad dnpliatta with Tss Assessor)
qn~n BUDD17 C'o.. Piaat Cft7. !u.