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' f Domicile and Citizenshi ~ooK 3 12
Declaration o _ P
ST. tUCIE COUNTY. FLA.
TO THE STATE AND COUNTY TAX ASSE.98OR,
3T. LIICIE COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.1?, Florida Statutes.
I wsa formerly a legal resident of______CIlL11R~tQ~1__________________________________------------ ------- SAAT:3~A3---------------
(Cits) ---- (State)
_ _ CFA ~~ - _ _ However. I have changed my domicile
and 1 resides ati-- - - -~ _
(u`:w, sad ::.u::~'-s?
to and am and have been a bona fide resident of the State of Florida since-.._. _30tb_._ .___- _-____.day of
~Y ------------------- I~----tid pad I :eoida ::L.___? L~~__w,n~_tz--C''~3~P~rt Bt,Luc~~a --- - -
----------------------------------- - (8treat and Number)
------------------~~---~----------------------------. ----3T.- I.IICR-------------------------------- ~-----aunty, Florida,
(fits)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(Insert here any pertinent tads. such ae sali of~yroperty oS ~ .o~r~ljnquishmenL of emDloymeat at
forme: domicile. removal of tamils to new domicils, pnre
919:~~
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(96t FfA -I AM g;~rE
S.. ~UCIE COUNTY, F~~~~.. .;
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements o! a legal resident of this State.
I r'C)K1~iEIt CEicl'1F'i That I nave nv in%euYoa w iF$~iirII to rqy foster domicile. and I intend to remain
in_ _ 1rT.---PI__BRCE -__------- - ST. ZIICIE------------_-_Counh', Florida,
(its) -'~
permaneatly. ~~L~f ~M- !ar.~-/
(Naar)
-.
sworn' tQ;i~;~~
. J•.
.t. ,ice:.
~- I ~
before me this-_l~i__day ci
A. A, 19~..
~.. n- T ~Y~- --------------
(Addnss)
DEEP. CL~
t
(pro b• ezeeoted m dvsakaa aa~d ~ wlti Clerk (~reok coats. asi davlkaa wits Tas Aeeeaee:)
~.... a.oar cw. rl.at clts. ri..