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~iJi 6 201
Declaration of Domicile and elb~~Y' ~l..
.......
TO THE STATE AND COUNTY TAX ASSJl'.8SOR,
ST. LUCIE COUNTY, FLORIDA:
Thi. it! my deelaration of Domicile aDd Cith.M'l~lp Ua the State of P1orids. thai I am ftliq th15 cia)' ill
accordance, and in conformity with Chapter 222, Sei:tion 222,17, Florida Statutee.
1 was formerly a legal reaident of__Qla.th.tL__'..'________'_'___________. Al!mtf.~__...__
(Clt7) (.....)
and I re8ided aL.. . 61QnW~.s't,_.san.d.tord_____,_.u...,u,._,__,__..___. However, 'I have ehaqcd "ll!1 domk-Ue
(Street &Ad Numbu)
to and am and hll.ve been a bona fide resident of the State of Florida sinte_____,...lS.th,_..,...,_,_________day :,f
___,..u,Q,c,tQ'Q~,~___,..'__n'_____.."m.__.' 19___.5.6, and I reside at.12.6__.o.caula..A.VAnUR ._.___,___,__._
(8tnet aM Nua)er)
u__..__'n"" n_'__..~~~,~"fi e r..~_~___"__,________,_" ___U_____h_~~. L ~.~J_t!________ _____County, Florida,
(Cit:-)
and thia statement i~ to be taken as my declaration of citizenship, actual legal reaidence and domlcU. in
the State of Florida.
(lnHrt here 'Il1y pertinent facta, auch .. aal. of Jll'opel1.J or bua1.r.aoaa.. 0;:' reliDqu; 1h:MDt of ..,.plo~ at
former domlelle. remonl of family to new domldle. pun:hue of ~ _>
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DOGER PO\Tf~,t.~. ~,~fr'\
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I FURTHER CERTIFY i:hat I wH! register at my local addre88 when the regiatration books reopen,
and comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiciie, and I intend to remain
~;::~:~~;.FQ"t;l'M~fennnmnnn.-m-. _n.n77~~~. <m.u.mrty, Florida,
~~.r:/-~~n.nn n.mnm
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SWOnl~'~..u~~.before me thiJL__'_n_._"tl.IIoY of
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~n;:.~';<:~J~lf. y?&--- ' , A.,D. .19___61
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;. ~>~" . wti '. tate rida at x.rc.
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(To be ~ ..dupUeaw and ori,maJ 61.'~ with elm ~ Court. Slld duplleate with 'tu Auenor)
Ro_n 800tllY Co.. Plant CiIY', Fla,