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Declarati~ of Dorrce~iI.. and Citizenw~ ~. t 7 ~
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TO THE STATE AND COUNTY TAX J\SSESSOR,
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St~Luc1e
.. COUNTY, flORIDA:
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This Is my decl.,.aJion of Domklle aOO Cltiz.nship In th. Sta.. of FIotIdl lh.t I am filing this d4ty \n aaordance,
and in conformity with Ch.pter 222, ~Ion 222.17, FIorIdl Statutes.
I was formerly a legal resident of ._~__~9J!~!t__Ql\~rJ.~~1;QJ1__--n:. _________, ___________Kest.._yirgini
ICIly) C$We)
and I resided aLu ,_,._4e3a:i__~~Q.r.klJLb.e___ __________.__. "However,' have changed my domkl"
CItrMt end ~) .
to and am and have bten .....boM fide residen;of the Sia.. of Florid. since__.:____5J,r~____________d.y of
A .
____ _ _ __ _ ... ugus..t
___, , '19 .-61, a~ I reside at _ ,_ __ ~_@__fJ.~LAy~....___,.___________
, CIIrwt 'end ~
___ F_o~,t Pierc~ _ ____ .:_ _ _,~ ____.._ _ ..__ _ ____, __~__ __5-t.LucJ.iL_____,_ __.______ County, Florida,
...' (CIty)
and this statement is to be ta~.n .. my declaration of citlzenabip, lldual legal rfiidence and domicile in the State
of Florida. .
(1-' ... .,.., pertln.nt teet.. lIUCh .. .... of pI'Opf'fty Of ~, Of ~ of ~lt .. -- ......
_el of f......., to .... ....., ~ of ~. Me.)
EnteringKaren ~lizabe)h Tackett in 11th grade
97786
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\9S\ nUG 29 AM 9: ~, .
PO''''"r.AS CU~.K
rt~ El~~ CQUNH, FLORiO"
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I FURTHER CERTIFY that I will reglste, at my local address w~ the reglatration books reopen, and comply with
.11 other requiremenb of . legal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicil., .nd I Intend to:rerNin in______
Fort Pierce,
.__,_.. ,,_ ,__ S_~~~_u.c;~_e _ u. _'_'. _ County, Florid.,
(CIty)
permanently.
~~'k..__,2-~-_-n
Kathe1een ~ackett
. _ _ _ _ _ _ _ _ _._ _ _ _ _ _ _ _ _ _ __ ~ __ _ _ _ _ _ _.. _ _ ._ ~ _ _ n H n _
(Addrna)
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, ' ..",l;"./t.,' , August 61
S_n to.: _,"~.""=.~f~..: t~'~n~n.."~~!~')!:. yt,j~:rz~c-:,__.~;;;;;ii.l:~_~. .
ROGER POITRAS, CLERK CIRCUIT colJa'f c' .~- . '; r ~' ,;-', .~ :. Notary Public
.. '. \ :. ',1 ... ! .. . -.: . . t L.arg~
- , ; . i. : I' . :":-, . Notary PublIC. Stale of FIOrid318S 1964
By n. __ ____ _______________,__._________=- .o.C. eJA'l ~Qf'M)If!iQr1 expires MY-eom~ExpilJ!sJjnr--~n..1'
.:. "..1....... '''l.~ J.' ': .'r--- .. f, J f. O.....n.riA:1 bv Alnerl(;an Sur....tv 0.0
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rr. lie ell""," ........ ... ........:~~.a.;. ~.b.t. .... ...... .... Tn ~)
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