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Dcclaratioll ~~T ,LBUN 1~~1 ~itizanshiP
TO T'IiE STATE AND COUNTY TAX ASSESSOR,
,3T. LUCIE COUNTY, FLORIIIA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day In accordance
and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Dlieida -- -_ TI• Y'
[City] State
222 Chapel St.,Kenwood 3tatfon
and I resided at However, I have changed my domicile
[Street and Number] a
1st day of
to and am. and have been a bona fide resident of the State of Florida since
December ___, 19 ~ and I reside at 171 Princiss Dr.
• -~ (Street and Number]
E'ORT PIERCE:, SAINT LUCIE COUNTY. FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence an3 domicile in the State of Florida.
[Insert here dry pertinent facts, such as sale of prop~7ty or business, or relinquishment of employment
at former domicile, removal of family to new domicile. purchase of home, eto]
Purchased .home
. ~~ ~ JET"~' ~~~~`~ ~ N ECO ED
~~ ~: ~ -~.a'; ~ ~• ~~-~~q Al dual ~ao o00K
~~ ' •:~
.;:,~'`~ '~fi~. r..'' 1962 D~.C I2 PM 2: Q9
.'s ~~2 ~'•~:"''i~'.Y~ ROGER POi7RAS. CLERK
~';Cf/ 1G.t ~~ i~
`1:,.,,~~:,,.. • ST. LUCIE COUNTY, FLORIOa,~j
I FURTHER CE.'FtTIFY that 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 FUP.THER CE:RT~'X that I have no intention to return to my former domicile, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, Permanently. /~ _ /
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. r<:, . d~ ~ pc~~:,
'~-,,.... r~s 1. c ~~~
3y
[To b$
ame]
Loren M. Baer
[Address]
Mary L. Baker
before me thin 12~h ._iay of ~Cembf3r _-, 19 E2
IT
' Notary ?ublic
D.C. ~Sy Commi.~ion expires
in do ~ original flied with Clerk Circuit Coact, snd duplicate ssith Taz Ass~or]