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7'O THF. STATE AND C.`f)UNTX TALC ASSESSOR. B~nK
3T. LUCIE COUNTY, FLORIDA: ~ ? . ~ ~, ~; ~ ( i ` ; ~ ~ ;' • ~ ~.. ~ .
This is my declaration of Domicile,aad C.itizenshSp in the State of Florida that I am filing this day in accon9ance
and in conformity with Chapter 222, Section 222.17, Florida Statutes.
~y,~le s Georgia
I was formt'rly a legal resident of (City] ~ State
and I resided at-..--~~~s-~-'-'s - -. However, I have changed my domicile
[Street and [umber]
to and am and have bin a bona fide resident of the State of Florida since 6t$ day of
November I9g~ and I reside at 186 a Route 2, Ft.Fieree
(Street end Number]
E`ORT PIERCE, SAINT LUCIE COUNTY. FLORIDA.
and this statement is to be taken as my d-claration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of grope-ty or business, or relinquishment of employment
at former domicile, removal of family to new domicile. purchase of home, et~•,
Entering children in school.
Ruby Lee in the 3rd grade
Randall in the 6th gradA
Carolyn Ann thb 5th grade
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. \`!~~i~'-r+ ROGER p~INR~SflCR10A
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_,.~~_;, ~~ ~T. LUCRE C-"'
I FURTHER CF~iTn?Y thak I will register at my local address when the registration b:oks reopen, and comply
with all other requirements of a 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
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentlg•,
,.~~:~~,. ,'~~c,,:; (4bs. ~ Mathew F#~~$~d
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. , (Address]
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,,' ...` - November 82
~rosn,.tv•~nti`~svbscribed before me this- 7th day of _--_ -- --, 19 __
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ROGER POITRAS ------------------------ --
CLERK CIRCC?IT COL'P.T Pdctary Public
3y _ D.C. ?1iy Commission expires_
(To be executed is duplicate anti origis3l fUed with Gier'c Circuit Conn, and duplicute with Tt:z Assessor