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Max ~,~abrtrr 633
OeclOI'ction of Domicile and Citixenshi~OO( ,
~ T, '- U'(:r .C~tllf!'l. rL.,
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE
COUNTY, FLORIDA:
This i8 my declaration of Domicile and Citizenahip in the S~ or Florida that 1 am ftlina' this day in
accordance. and in conformity wi";h Chap~er 222. Section 222.17. Florida Statutes,
I was formerly a leq-al resident; Of.m......SALFJ,L..h_.......,...h.h........~_m...m......._.,' _._.I.ND.I.ANA-:.._..___..,_
( CitrL (Stat.e)
,... However. I have changed my drmici1e
ROll' e 1 ..,......................_.m....
(Street aDd Number)
to and am and have been a bona fide resident of the State of Flori:la !Iin~e" 14th. ,.... ,..,. .......... day of
and I resided at
...... ........ 19..5.9. and I reside uL.500.Z..Reg.ina..D.riYtl.,__..._.._..__..............._....
(Street and Numbe:')
.....0..'. _. ... .._' m_....._....m.'. ..~.~.. u. ~\lG i .Q_'_""h'''O ......h.........._._.......:..... County. Florida.
(City)
and this statement is to be taken a8 my declaration of citizenship, actual legal YesiOen('A:! and domicile in
the State of Florida.
A.pril
Fort Pierce
(lnaert here any pertinent facti;, luch as ...1. of property or b~ or relinquiahT.l.llt of employment at
fOTDPr domicile, removal of famil,. to new domicile, purchue of home, etc.)
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, /
93555
FILEO MJO RECORDED
I~~ ~~(~_~..L~f:,~]K
IC"" ::",'": ')(1 P\~ 2' ")'
I.... 1I.d '" Ii _0/4
~/
v
-'
s :, L U C Ii: C G U ~ 11. F L 0 ~\ I ;u\
I FURTHER CERTiFY that I will register at my local address when the registration books reopen,
and comply with all other requirements of a legal resident of this Stste.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in .._F,ort P~~r.ce_h..nh
(City)
.._..~_~,!....~~~.i..~.... ,...... .'_.. ....m...'.. ..._. ..County. Florida.
c;~ '
~A,c.~......~-~:f..'"1..~~~,C\.,_.......,
(Name)
Hax Ashabraner
..._--~.-_. -- ...-....--.- ...-. -...----,
permanently.
- -_.--------- ..-_.-.. -------... ~-' - -.---------- --------. ----- ---------.---
( Addre..)
Sworn to and subscribed, ,~~o~ ,~. th!s..__...29*y of
__~)i1J:~g,..., ,... T"';'"':~''''''' ,.~.' ~'I:A: D, 19..J>1.
/2?0:X(~"(7'1t:1'-),* /:>-'H0tC1'
---- .....----- -.-. . - ~.........-_....- --- -;_.-~-.;:..------------_..--_.
, Notary Publio S~te. ,Fl, :'J\.~.
M r'~ .. . "':',~, .<"1/63
y \J1JmIn.l88lOn explre8.... .._L.,....._.__.._......___.__
(T:: be executed in duplicate and oncinal filed with Clerk Cinult Court, and duplicate with Tu: AI"""l')
Ro1t""Pn ::;uDol" i'~.. Pllnt City. .~lft.
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