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Declaration of Domicile and Citizenship ~ooK 4 82
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ST, LUCIE COUNTY. FLA.
TO THE STATE AND t'~UNTY TA% ASSES.gOR,
sr. iuc~ ootm~rY, FzoRIDa:
This is my declsntia~n of Domicile and Citisenahip in the State of Florida that I am filing this day in
socordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a kcal resident of______ CL~YB~LANII-_____.__------------------__---. ------------______~ils2__
(C[b) (Stag)
and I resided at_.58I8__Cl~bourne A~enua --------------------------- However, I have changed my dornicik
(StsMt sad Nmeb~r)
to and am and have been a bona fide resident of the State of Florida since__-_~.~t?L_.__._..___ _.__-__._day of
1[aroh 1860 and i reside at_-1010_I~ebraska A~enns ___ _____. _
- -- --------------
(8tr»t sad Nnmbar)
fort Pierce St. Luc ie -____County, Florida,
ccxtl
and this statement k to be taken as my declaration of dtisenahip, actual le~cal residence and domicile in
the State of Florida.
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I FURTHER CERTIFY that I will register at my local address when the reQistrration books reopen,
rd ~ with all :~Lhe. re~;:i.~ts o! s I~..l : -~.~:t of t °:twte.
I FURTHER CERTIFY flat I bare no intentioe to return to my former domidk, and I intend to remain
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