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Declaration of Domicile and
113790 o. R,
Cith 'nship Br(~
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TO THE S'rATE AND COUNTY TAX ASSESSOR.
ST. LUCIE CUUNTY, FLOIUDA:
This .. my declaration of Do.rnlcUe and Cituelllhlp In the State of Florida that 1 am mIni this day In accordance
and in conformlly with Chapter 222, Section ~.17, Florida Statutes.
I was formerly a l~al realdent of.
Washington
[City]
D.G .
State
and I realded at ~;:::20 Sherry Place N. W.
(Street and Number)
to and am and have been a bona f\de realdent of the State of Florida aince
How~ver. I have changed my domicile
1st
day of
August
Port St.L.lcie.
FORT PIERCE, SAINT LUCIE COUNTY, FLORID....
, 19~~ an4 I reaide at 240 Celestia Court
[Street and Nwmber]
and lhis statement is to be taken as my declaration of citizenship, actual leial residence an1 domicile In the State of Florida.
(Insert here any pertinent facts, such as S31e of property or bwlneu, or relinquishment of employment
at former domicile, re:Tlo\'al of family to new doml cile. purchase of home, etc.]
App1yin8 for homestead
113790
f\L(\) f\HU RECORO~{) ~
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ROGER P('I'IU\\1~ fl\Jf\\\)~1
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I FURTHER CERTIFY that I will reg1ater at my local address when the resl.'istro.tion b~olu 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 fonner domicile, and I intend to remain in
~ f~ ~kd (f, f~tL/(
Eliaerbeth A. [~~eAel'
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
.
[Address]
Sworn to and subscribed before me thb
7th
March
19~
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['10 be executed In dupUcate and orltlnal rued w1~ .~. ~- court, and dupUcate with Tu .Aneaor)
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ROGER POITRAS
~ CLERK CIRCY)T COU~T
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