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t r . ~ ' . . . . • . . i i ~ ' . . . ' ' ~ ' ~ . ~ ~ ~ ~ f~ . . • . ~ . ~aluation _ot Oomiclt~ and Pitis~ship . :1,26285 ~ ° ~ . ~ . = . , , . TO THE StATE 11ND GOVNiY TAX IISSESSOR, ~ • . . . i . . . ST: lUCIE GOIJNTY. fIORICAe ' . _ : ~ . ' . : ' ` _ . ~ ' c ~ ThK b my d~daration vf Oomkil~ and pti~n~fiiP in tiM Stat~ of Florida tlwt~ 1 am filtnq ~ da~? i~ iooord~no~ ar.d in ~oe~famity whh ChaptK 2Z~. S~ction Z2~.17, FIaWa Sbtuta. : . • . - ~ . 1 wa ~ornwrly • Ip~l t~sid~nt of O~n~~. ~ ~Q• ' . ' ~ ~ , ep~y~ {Stat~I . _ , . - . . ~ - _ ~ . ~ - ~ : . a~d ! n~td~d at ~ 514 8. R. 17th _ St. : ~ floww~?1 h~w.chanq~d my do~nidt~ ~ (5tra~t and Nwr+bK) : ~ . . a.nd arn a~d iwv~ b..n . bon~ flc~ n~id.m o~f th. Stab of Norid. ana let ~ . d.y oi Ootober . ds ~ ~ lE~ S; 7th St. - _ . ~ ~ - 19.r_, ~nd I ~id~ at - ~ ~ • . - ~Str~at and Nwr+1~1 , . !'ORT M~, i~AMIT LtIC1E OOi1N1Y. lLORqA . . . ~ . ~ - . , s~d fhti st~~wrMnt b a b. ak~n a my d.d.~ation af ci~i~hip, acfwl Ipal rakiN~a Md domidi~ In tht Statr of Fioridi. - ~ pm~t h~n a~? puNnem fads. wch a sale of propsrt~? or b~i~ss. or nlMqui:lmMnt of ~nplo~t , . ~ at form~ domicil~, nn~oval of family to ~ew domtcil~, pur~ of taew, Nta . ~ ' ~ 01~3! CffiI.D ?li ~'OHLIC BCHOOL - . . : - - = , , • Gretihea ~nn Ys~er ~4) . . , . - ~ . - - . < - . ~ _ - . , ~ . ; - _ _ 8~p~ ~ : , ~ ~ , . 196~ j,it~jl' ~ f ~ ` ~ ~ _ _ t~ -1 pM ~ 53 . ~ ; ~ . ~ROG ` - 4 _ ` " : _ ~ : ` ER POITRAS. ' _ r . _ _ . . ~t. lBCiE COUNtT. FLO~RI~p~ - . . _ . _ - - . . ~ ~ . . , ~ . _ # . . . . ~ . . . ~ : . . . ~ ! .Y.> -_=t ~ : . _ . : . ~ - , . _ ~ . - " _ - ~ y ; , . . . . ' : . : i t ~ t. . ~ . ' i ~ ~ , . µ . . . ~ •~o~ ~ ~ ~ ' Y . ~ ~ ~ E . # r . . ~ r. • : - t . ~ ~ , _ . - ~ • z. . : ' y - . _ - . . ' C. ` t - ~ , . -r ' ~ • . . ~ wt ~ + s ~ : _ , , ~ f.' . . ~ , , . . r ~ ~ ' o.~ .~.t r, ~ i- . ~ . . - ~ ~ ~ . ~ - . - . - . . . • * t r ; ~ . ~ s. . - • . . ~ . ~ •f . . . . . • ~y u,~ ` ~.,-t. ~~~~"1 ~t~w'~~ ' ' ~ . - all"olfi~t nquinm~nb of a le~at ~esidoM of this S~sfa. . ~ . ' ~ . 1 fURTHER CERTIFIf thst t havs no ~iMenHon 10 lMwn,~o mY fo~m~.do~~k, ~d 1 iM~nd 1o'nmaM i~ FORT . PIf.ACE, SMNT WCIE COUNTY.. FLORIDA, PKm~nendY• • - . . _ : . . - - s . . ~ _ _ . . . . Odai+~ . • ~ • . ~ . _ ' - . _ ' ~ ~ EASZ C.~ ]Q!!~t ~ ' . : : . - - ~ ~ . ~ ~ ~ ' . - _ . . _ . - _ . . . _ . y ' . . . . . " . . _ - , j . ~ ~ _ .~L.~aw~~~.. /j . ; . ~ ' . f rM/~ wir . ~ . - . . . ' ~ . . _ . ~ • '4 ~ ' . _ ,r_ f . ~ . _ ~ , i ~ ~ • ' ' ~ . • ~ . ~ t • , - t ~ , • . ~ 5wom b+~nd wb~aib~d ~ ~ day of 19.-...... ; • r - . ~ ~ ! . - • . - ~ ~~t"~'~ ~i . . : i : _ ~ R~ lOi~RA: ' • ~ r~^'~~ ~S y.l : ' ; - , : j}~,`x: r!' ; ; W ' Not~ry Prlblk ` , . q~RK GO~RT f ~ ? r , L~r;,~j ~ i ~ . ~ . - . , ~ - ~ ..~,..Dv~~, M~!? ~~^''`~~t''~ - _ 1 . . . ~ . - ~f~ t~CE~~~ _ - . . s~.1 ' ~ - - ~ . - (Ti M~a~i iu +i~p~cM~ «~i ai~Mal AI~ wNM CM~ic Ci~a~lt C~4 ~1 ~aM ~M Taec A~wK~ ' -