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Declaration ~t.E~O~TQ~ Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR.
a+ T.„Ci@ COUNi1f, FLORIDA:
_ This is my dedaration of Domidle and Citizenship in the State of Florida that I am filirp this day in oeoordance and
in conformity with Chapter 222, Section 242.17, Florida Statutes.
.. ---------, --~~-7sl.and-+- ~~Y.
--------- tSa~
was formerly a legal resident of____$aysi ----------
(~r)
---. However. 1 have changed my domidle
and 1 resided at ___--1~=~-~-~~Y~~-------------------
l3Kaa, and Numbs)
to and am and have been a bona fide resident of the State of Florida since_______1$tc----------- ------ day of
Route 2 Box X3501
----------I2HCEtnbEZ----------------------• i19__~~., and I reside at ___~.~4SLk~~~ ~~e----------
Fort Pierce St. Lucie
~- ----------------- County, Florida,
----------
-----------------------tC„r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
faeb, wd~ as wM of propa,y a buainaaa, or nOnquiatmwN of ampbrman~ at former domkila,
p„~.rt.Mra cry part~na+K
removal of family w new dwnidM, Purdww of boraa. Mca
Establish Residency
10~
~ X01(
1962,UW 27 qM gyp; 06
sRLBC E COUHI- F~B~R p
~~C
.. .....
I FURTHER CERTIFY that I will register at my local address when the regiatraYwn books reopen, and comply with all
other requirements of s legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and i intend to remain in
~. ,~. ___________ County, Florida,
----F-~erC.a-----~~ ---------
• ..::. -
'~ +Y .
~s'- >
~.: r
_ ` a! r~'' ' ~ ~ • ~~ + ~ .'~rj}^ry. ROUt e 2 Box 3 501 _ - - - - -
..°' ~•.- ~.. .;:~•. 27th _day aF ---J~-------------_.. _ __ , 19-~2.
~.~;~; ~y~' `' before tl+u-------- ----- ----
_ .
~ ~ , ~, .
_ .
-----ROGER -- - ------ ---------Notary isubik
,CLERK CIRCUIT COURT
gY ---- `-
__-- D C. My Commission expires ~ - _ --
R. M a~sMd r irw at/ «Mt~ ftia/ rM Clark Clrsae fatrf, ar ~~ rri* Tars Maan[d
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