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O. R.' 611
80JI .
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Declaratior\ :~ Domir,ile and Citi.zen'stii~CI[ ._c9~H.n, HA.
...~
TO 'mE STATE AND COUNTY TAX ASSESSOR.
5T. LUCIE - COUNTY. FLORIDA:
This ia my declaration of 'Domicile and Citi.zenahip in the State of Florida that I am dlinl' this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Sututes.
. BAYTOWN TEX.
I was formerly a lepl resIdent of.__..........__...___.....____.....____..._._..._._., ------.......----
_~ (Clt7) (Sw~)
and I resided at 6~~?~~~X~.~~._P!:'~~~......__m..__.........__.__. .._.. However, I have chanJ'ed mi domic.Ue
, (Street aDd Numbol')
to and am and have.been a bona fide resident of the State of Florida 8ince.........~4:t~......__..__......c:hly vf
.__.__~1M~JL......m.--.....m..h.....m..' 19....9J, and I reside ut.m335...MiQ.1'l~8~y.-:rN~;;;tLC.i.ty.....-..m.
FT. PIERCE . _ ST. WCIE '
...... ._.__...... .... .h'..n__ ......._____. ......__________..__..n.' ...... ..........._ _...___....._____..........__.... _..._ _'n. County, Flonda,
(City)
and this statement is to be taken as my declaration of citi:z.enship, actual legal reeidenee and domicile in
the State of Florida. -- . .
(Insert here any pertinent facta. auch -u ...1. 01. property or buaineu. or reUnqlliahm.~t 01. employment at
fomu domicile, remo...al of family to new domicile, pure~u. 01. hODW. .te.)
--
ENTERING 4 four children in Public Schoo1s--
ELIZABETH ANNE
Al-TY LOUISE
BERNARD ANDRE'^'
13 yrs.
11 yrs
9 yrs
7 yrs
LINDA 3UE
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11:" R~CORpEO
IN ~~aoo~
19! tlPR' 0 m~ 8: 40
Ji:tUCIE 1~~u~~th~~;rA ~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements of a legsl resident of this ntate.
I FURTHER CERTIFY that I hn\'e no ini-ention to return to my fOIIDer domicile, and I intend to remain
in. .__m ..F~r.. .. f~.E.~.Q ~ ___..__.......... __ on ._d. .._....... ..... __ ___.__, ---. ..d~1'_!_ ---~Y. 9.J.~.... on --_... ..... ...----..- _County, Florida,
(City) #}/. / ~
permanently. ...~~....~_L..n?!Z__._~~_4::.c.:~
(N &iDe)
/'
.___.?oms ...mVIOLET..x... ..MlINSEE _._. ....... ._. .. ...._.__n
(Addre.. )
CLERK
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