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Declaration of Domicile and Citizenship
ib~i
20 PACE112
10 THE STATE AND COUNTY )"AX ASSESSOR,
St. Lucie
~T. ~UC!E COU~TY, ru.
COUNTY, flORIDA:
Thil il my dede,.tion of Oomidle end Citizenship in the Stete of FIol'ide that I -"' filing this d.y In ~danat,
end In confotmity with ctMpter 222, Section 222.17, Florida Stetutes.
I w" formerly a legal resident oL___~~.P.~<?!l---_..--- ---- -. --------------,
(CIty)
Virrinia
------------..--------
CStete)
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and I reaided aL___?.9_QJ)_~!!l_t._~_C?.I!l!'~~~u~y!:.~~__:_______ -----. However, I have chenged my domldle
\ C$trMt .. ......)
to end em end MV. been . boN fide reaident of the St... of FIOIlde sir~___ _' ~---------_.--------..-~y of
______Octoher_______ ..._ ________, 19.J?~., end I reside at _?l!~__g~~~~?:~_~~~_~_____________ .
CStrMt end N-.mMr)
Fort Pi erce St. Luci e .
_____ _.__ .____' _____..__,________________________, __________________________________. County, FIotId.,
(City)
. and this statement Is to be t.ken " my declaration of citizenship, ~I legal reaidence and domicile In the State
of Y;!orIc:M.
(JNwt here ..., J*tInem fecta, IUCh .. .... of properly _ ~ _ r.lMqI..lttoll'" of ......,_ot et '-- ......
~ of fMlity 10 _ ...... ~ of home. -.)
En~ering Devra TCV lor in 3rd Grade
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f\lEO AND RECOROEO
\N~O']K
\~ OCT' 0 Qr 9'. 01
~o"t" ~'IRAf. tUl~
~ . ..J J I [ C 0 j ~ 1 '-.1 ~. _" ,\
(19~
I RJRTHER CERTIFY that I wlU Ngiater .t my local acIdtfiI when the registration boob reopen, 'nd comply with
ell other requl,...-..t. of a legal resident of thl$ Sta... .
.. fV~~~ ~TlFY thet . have no Intention to return to my former domkil., .nd . Intend to remain in______
..:~~~~~~~~~~C!-------------~------ _. ~~_.__~~~~~____________________ County, Florida,
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. '/.. ......... ,;'" "Mr.. III G. Tavlor
..," f.e _ cO) 'c.,. ~. --- .__________________'t..._________________
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Sworn to and wblctl'*i before me this_ _1..Q_____ day of _~_~~~~~!'___________________~_, 19__~~_
-.E ~t-.Ei~e...----.------------------------ S t & _t.ll.~_~_________________________________
ROGER ~' aeRK CIRCUIT COURT Notary Public
By _~__ __~-----------.-- D.C. My CommI$Slon el<pira --------------..------------
Ct. lie ........ III ....... .. ~ fW ...... a.It a-It c:-t. _ ....... ..... TN ~
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