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Declarotio~ of Dlom~ p
:ST. LUCIE COUNTY. FLA., •
TO THE STATE AND COUNTY TAX /~-.SSESSOR,
S~ T~ei w c'nuNTY, FLORIDAi
This is my dedaration of Domkila and Citiaenship In tM Sta» of Florida that I im filirp thb day in accordance and
- in aonfomnity with Chapter 222, Section 222.17, Florida
Broad eM Heights
I was formerly a legal rotWent of_____-- C.~4t4~$$S~. ~k~-----------------, ---5?hiSZ___________--
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and 1 resided at __-$PZ'$g~~ -B4ad________w------------------. However, 1 haw d~argsd my domidls
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to and am and haw bean a bona fide resident of the Sta» of Florida stns__-- ~~~~-------------------- day of
---------- Ati~l~i8t -------------------. 19_6_, and I reside at ---~7~_~.QT~_.~~CQ~_-----
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---------_.Ft.~..PieL"re._ __ ~ T~`ni ~--------- Canty, Florida,
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and this`:tatemsni is to be taken as my dedarstion of dtinsnship, sctual Ipal residence and domidle in the Sta» of Florida.
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ROG~CR POITRAS. CLERK
it. ldCiE 60tlNTY~O IOA
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1 FURTFi~t CptTiFY That 1 will tpister d my local address when the rpistntion books reopen, and comply with all
other nquirernents of a Ipd resident of this StaTO. ''
1 FURTHER CE'iTIFY That I haw no intention b rrTurn to my former domidle, and I Intend ~o remain in
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