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Oeclar~tiori ot Domtcii~ a~d Citisenship -~83S
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TO THE STATE MtD GOUNTY TAX ASSESSOR,
ST. UKIE COUNTY, ftORID/1:
thit !t my d~tlintion of Opmicil~ snd Citi~nship in tM Stat~ of Florida that 1 am fllinp this day tn aooorda~a and
in oonformity with Chapter 222, Sec~ion Z22.17. Florida Statut~.
I wa: forrr~ly a Ipal rosident of ~x'lotteev311s . Y12`giAl.a
~ . (Cib) , (St~h)
•nd i ~wed •t 22~+0 Bambury Street , .
. How~vK 1 haw chsnQsd my domW1~
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~ to and atn a~d haw besn a bona flds resident of the Staro of Fiorid~ Nno~ 17 day of
~ ~ . 19 ~ and 1 resids at ~05 SeawsT D~ive
. (Street and 1~1uRnbs?)
~ . I~ORT MERCE. sAINT LUCI~ COUNTY, I~LORIDA . c
a~d this statement if b bs taken as my dedaration of dtizar~ship, ectval lepai residsna and domidi~ In th~ Statr of Hotid~.
qn:erl here any pertineM fact:, such as sale of property or bustneu, or mlinquishmsnt of ~cnploymaM
` ~ at forme? domidls, removal of family to new domtdle, purchass of horr~e, etc.) ~
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E~atering daughter in sohooi RfCORd~ •
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~ °-'-~1'FURTHER CER'TI~Y that t will . ~Y w~~
~ ~ ali otF~ roquiremsnts of a le9ai msident of this State: _
! 1 FURTFiER CERTIFY that 1 have no intenfion to ~etum ro my former domidle, and ! intanc! to ~emsln in FOItT
+ PIERCE. SAINY LUCIE COUNTY, FLORIDA, permanently. . ~ .
i ~ . • ~ ~ `''~,:.~,rt,..~~'~~f~ ~
~ ~ (Name)
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_ ; F"~~`f;~;:~~,~~;; Zsobel L. Frietoe
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~ Sworn b~nd :vbsalb~d bffor~ r~n~ th4 21 dsy of ~~t ~ ~q
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~ ; " C . Notsry Pubik .
; i ~ 0~ . My Commtssbn utpir~s
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~ : 1To 6. puiw~a ia ~
. ~lk~al..ad .ei~i fq.a wiH~ a«k u.wN Coae~, .na d~rpNc.» wi11~ Tax
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