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[- Declaration of Domicile and Citizenship ~, 16 rul118 ~l:lUc'E tOUMT1,.!.~~. . ...- _..._-_.~ ThlaJs my decI...atlon ~ Domicile end cm.n.hip in IN SMte of fIoridI that I 1m flllng this .y in MXOtdence. .net in COI.formity w~ ChIpIw 222. SectIon 222.17. fIIoricM StnMI, , . TO THE STATE AND COUNTY TAX A$~* at .-Lucie COUNtY. ,flORlDA: I w.. fonnerIy . .... ~ of_______p..or1;..~*_---------------------. ______0h1G...-------- Qw) CIIeIe) end I r..acted et_______,~~~~_~~~__f!!i~!~_________________. ttowe'i8f. I he~ dMnged my domicile ..... ... ~ to end em end hew boen . ~ fide ~ of the St... of Florida sJnce____~~____________________dey of _____-=-____'''Pltt._______________. 19__~1_. end I ,... .t ______~p~_4!.._~~_}.!Q9__~~.!1!9~_!>tl!! - .... .... ......... ror~ Pierce St. Lucie _______________'~_________~___________________. __________________________________ County, AOf~, ICIlY>> .nd thla Ita*,*,t it to be tebn .. my dedentlon of, dtBnlhlp, ectuef .... ,..ldence end domld1e in the ... of~, l'-' ......, ........ ...... __ . ...... ......,.......... . 1.1 .. 11t..-.. .. . .,h..... .. .... ....... .-.I .. f"'" .. - ...... ........ ., ...... -.) Entering tlfO chl1ctr.l J get Lee Arthur ill 4tbGracle De.j~ur ill lat Ora4e "~~.I- . ....~n~!!"fAl.. ..... ..' 00 r.... '!o, " ....... ".. ".::/1 I. ,. ~l.~ ,7.......... " .". :- ,.;;' ...... ~ ,- ~... ~ " ... / "'~\ .."'1/,"'",....... "f ..-' ' J', ....,"'r.. "'.~..~ ".. ' : , ".:.::l l. '.f... ~,' ~ , : ~ : (7' . ~.~.; " ~ . ~? ,:1 .,&" . . : ;. ~ -.l'l.. ~. :.:.:. -~~... ~ <$. '. V '- ~.,' '. ': -:>0.". 1/00'50:'. - -~, ~,~".:..":.:~') ','. 710'1 ..... ~5' ....., .,' ~:~~~:~:OK 1961 AOO I 2 AI'! 10: 22 ROGEr, PO IT!"' '" ~'r,"'," I\k..., '.L, ,'\ ST. LUCIE COUNn. fLOkIU~ ~..:, .'" . .,."..".,.::.~~.. ~.~ .v.~~ .'- -~ - 'J I . -~, -- '..;....fl--:~' , . .. .,... ...'~, .. ... .' . '.. , ..., '.'''\' , ' ._" -'. ....'6. "'-..'r_ (" ,,' ~ ~ ~ . . ", 6 I,,~ . "",..... '\, .; ..1, '.<1,' ",..." S...... ... :6 ~. '-.... # "," f'>.- '. ~.;> " -4: t.:~/'(,': '2' ~':. =, ' ,;t,." .. - :,..,,:~::.~.,\\~/./~. . '"#. " ........--.. '... ~ ., # ..... ... , "'" I r 0 ') . 1"". ,.... " I FUITHEI CERTIFY thet I . ,...., at my IoalI edc:tNea wt. the ~ boub ..... ... CIIftIPIy with" .at oIMr ..... ........ of . ItoII ,....... of this St4R.. " " , ' , MfHEI (ftffF't thM I ... no InIentIon .... .-urn to ,.", formtr domicile, end , ~ to NIMIn L_____ ________tod_'.1.r.u---------------~--- _ _' . ________!~~_.M9.!!,_____------ County. ~ tcIIIt ' ; ,......er. - --~--~ , ..... __~!YI~~_g~__~~-___________ , ~ u . ' Q' Sworn to'" subecribed befoM me thk. ,,- .______ day of :..-_.__..:~_________________. 19______ :-~fZ:d~~:= My ~-=-~-~~~~=~=~~= L tv............ . ......,................_~..... ~... '" ~ .~. ". ...... -