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58 Uhf t 91
Declaration of ~dJlC...t~P
lt3f;~)1
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TO THE STATE AND COUNTY TAX ASSESSOR,
~T, LtiCIE COUNTY, FLORIDA:
This is my declaration of Domicil,) and Citizenship In the State 01 Florida that I am filing this da~ in n~cordance
anti In conformity with Chapter 222; Section 222.17, Florida Statutea.
I was formerly a legal resident of
St.Louls
( City)
I'
"'\...0.
.
State
a'\ I I reside!1 at
3429 St. ~illiam
. However, I have changed my domicile
(Street und Number'
tu anll lllll Bnd hllve bE'en a. b~nR fide resilIent of the Slate of Florida since
2Sth
day of
1"e bru:l ry
~3 .l'lf.." ,
19~;:-,!llldlre8ideat v.ios...yn
(Steet and Number)
F~mT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
",'d this slnlt'~lIent is to be taken as my declaration of citizenship, actual legal residence and domidle in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicle, purchase of home, etc.)
Entering rtobin Michele Jl'imes in -tlh ls t 13r<.:.:l8
J 13()~Jl
f\lED ~N{LRtCOr.nE~""
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I FDHTIIER CERTIFY that I will register at my lceal address when the registration books reopen, and comply
wi:', a II .thl'r )'c'iuirements of a legal resident of this State,
I FURTHER CERTIFY that I have no intention to return to my f,mnE>r domlciJe, and I intend to remain in
FOI:T PIERrE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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I? (/;)7,
. .~ .., ~(Name)
wrs. uodney ur~~es
'-./.)J
'( ,7r /~...l j
(Address)
:".\'(\:!1 :0 allll ~uh.<cribcd bdore me this
"1
1:8 rch
___119 63
day of
JWGER POITRAS
('I.I.;RK CIRCUIT COUR1'
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l. 'i).~ .... ,M,. COJP.mJiaJ.Qn npires
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(I~ with,: Clftlt C~',Court, and duplicate with Tn Aase8!lor)
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Notary Public
tTo he eu~utrd In dupllcllte and original
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