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Dec:iaration of Dornicilp. and Citi%e~shjp.; u tIE C - -
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1'0 THE STATg AND COUNTY TAX ASSESSOR,
~~ Lucie COUNTY. FLORIDA:
Thia in my declaration of Domlcile and CitbeDabip in the State of Florida tha.t I am tiling this day in
&C<'.ordance. &DC i.n confonnity with Chapter 222. Section 22217. Florida Statutes,
. T . Albany - ._~_~_~_~~_~_____.nu______
_ _ was fermerly a lepll'6$ldent oL_______..._______ __________m_.____. ._,_____n___________. .
(City) (Sw,t8)
_ ~ 918 Radium ~pring5 Road H r I have chAnged m domicile
and I resl<!ed a~____n.____ __..m_hU_n__________.._..____________..________.._..._____ ,__w__.____ oweve · y
_ (S~ a:d. Numbo!."~ ., 23' .
to and am and have been a bona fide resIdent of the State of Flonda SInce _n____n __n..________n_____.. da) of
____U___h____~_~_~!~~~.X________u_ ...____. 19__~!, and I reaide at..n___?:t~Qu~ ~__J.2~h __~J1_l:~_~____u__________. - -..-----...
_ (StrMt and Number)
______!_~!'_~_~~E_~~ _____mu_____________, _______.___ _. _~ t .___.!:-~~J__~___________ '-- -- .___County. Florida.
- (Cit}')
and this 8tatement ia to be taken as my decla~tion of citizelUlhip, actual legal residence and domicile in
the St&te of FlQrida.
(lnMr\ bere any-pertinent facta. .uch as sale of property or blaineaa. or rellnquiahment of employment at
!o!'IDer domlelle. remon! of f&mil,. to new domicile. Pun'han 01 home. .u.)
Entering Billy Webb in 4th Grade
n Tim Webb in 11th Grade
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ROGER POITRAS. r,tf~~:
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I F'URTHER CERTIFY that I will register at my local addre8a wben the regiatration boob reopen,
and comply with all other requirements of a legal resident of this Stat9,
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
St. L-;J.~ie Coun F1'da
_ _ ______ ty, on ,
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(Name)
Everett Monroe Webb
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Roger Poitra3, Clerk 0 fCircui t Court - ~~-. : : ,.' ~ +. ..- ;: ~
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""_ -.aelMY c.. Pleat elt" ria.
Fo_r~._Pierc-e
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pe!,,1Unently .
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Sworn t!> IU1d 8ubt;eribeci bd~ me thil:_~-__dI-1 of
. ____Ma:r-c:h . A.. D. 19-61.
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