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IJ. Moore
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7
600
Declaration of Domicile and dfi:~W1lfsh~iY\ FU,
TO THE STATE AND COUNTY TAX ASSESSOR,
_ St. t.\l~ie
COUNTY, FLORIDA:
Thia is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statut.?s.
I was formerly a le~l resident Of.-m..._....-.:.....Spr~8.t;.~alley.m'.-.....--...., -u..m...m.-.(,s~-:;)Wi:..y ork
and! resided at.......... ..-:-34... LaEay.et.ta..S.t.r_e.et.._.... ._ , However, I have changed my domicile
(Street and Numbe..)
to and am and have been a bona fide resident of tpe State of Florida since 4 th.. . ' . day of
_n_h__m.__nm_~P!_~_~m..m_...w.__., '19 __~~.; and I reside a Luu.caus eway---Tr.a.i lor .Ear-.k _.u -- w..........
. (Street and Number)
------F..o-r-:t. -~i_&r_c.6--- ,.____u__________:.___.., -_.-.~~. Lu-ei-e--....------..-. ......,m ____u__ nn' County, Florida,
(City)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of- Florida.
(lnaert bere any perUDGlt facta. .uch u aaieol propert)' or buaineaa. or relinquishment of employment at
former domidle-zwm\)Ta1 of family to new domicile. purehue of home. etc.) .
Establishing r~sidency
93907
. FlLEO ANO RECORDEO
IN~~ ~OOl
\96\ APR -7 PM 4: S3
ROGER POITRAS. CL(f.!',
. Sl.lUCIE COUNll, FlORIOA
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. I FURTHER CERTIFY that. i will rePiter at my local addreea when the reptration books reopen,
and comply with .n. othe};. requirements_of _& 'ep} resident of th1a State. .
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I.FtJ1rrH1i1,R CERTJlf'{ tb-i lbaVE\ no mtfo"\t1tn1' to mum to my former domicile, and I intend to remain
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i . . __~FGrt PiJit'l!8' -'" _ St.Luc1e _County, Florida,
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