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Declaration of Domicile and ~;t1%ena.fp
TO TnE STATE AND COUN'fY TAX ..l.sscs...~R,.
St. Lucie CO~TY, FLOR::>A:
Thia ia my deeluation of l)Qm.k:lli) and Ciu.elYhip ie. tDe Sta~e of FlOrida that I am ftling this dar '1
accordance. and in conformity with Ch9pte.r ~, S<<tctioo 222.17, FloridA Statutes.
I was ft'nherly a 1epl i"Wd~nt of. _.A~.!~_~~_~~____~~_____m__u__.'.__m_____. u__,_~.!7_~~~~_......_ "-"
( City) (State)
and 1 resided aL.....___ ).~_Q7.n.~_~~th~!:P-_.~!.~_~~~.J....uu..._.u_ ..--' Howilver. I have e~ my domkile
(St.rwt ADd NflDlber)
to and am and have been a bona tide resident of the State of Florida since,....nn.u29,..nn__..n.___.... Clay ot
~ Augu.st' 60 ' 1510 IndianaAvenue
u...u_._..__u__.____.u..________..um__.__, 19.___._, and I re6!de at....___.____,______.____.__.___________..___.._.._u.__..._-.-.
(8tnet and N~ber)
_.h_________.!.~~!_..~i erc ~_______ .__. __.______ St_!-~~~~!.._._____ ..h..COunty, FloJiJa,
( Cit} )
and th!s statement is to be taken as my deel&ration of cltize118hip, actual le8'81 residence and domicile in
the State of Florida, '
(lnHrt nen any pertinent facta. lueh u ule ofp!'opertf Of bl1liDeu. Oc ~quiahm.nt 01 emplo7_t at
fOTlD4lr dcmici1e. \"ltmoTal of tr.mlly to new domicil.. ))1I1'ChaH c1 1:lo1M.. .)
Applying for homestead
92788
F'l rn t\in R--j!DOEO
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!':.~ ..-_BOOK
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ROGER POITRAS. CLERK
(' -:- I 11"':' t'-) 'I ~J r" 'I n c .-' A
v l. . . oj _..; 1 I, I '-' d tl ~
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I FURTHER CERTIFY ths{; I will regiBter at my local address when the reiUltration bookB reopen,
and comply with all otl.er requirements of a legai reeident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
. Fort Pier~e St. Lucie .
1D-____u._______._..______________._____, ____ _..________._.u______u___COunty, .Flonda,
(City)
permanently.
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(Addres.) .' ,...;.....;;,/; .
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~__-BY: U4&.J~ IY - e. ~ . · ,.<}:..,,~~:<~~: .'
(Tc be eneottd in dilp!leote >>.nd ori,m.J i1Jed with am ~uJt Court. ad ~!ieI&te with '~~I~)
Sworn to ~nd lub8erlOOd before me t.ii8.__~___.___day of
~~rch 61
____ ______.__.____.____________, A, D. lS___._.
ftn_.. hll1)b Co., Plant CIty. n..