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~ Oecla~ation ot Dornictte a~d C
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~ TO THE STATE AND COUNflI TAX ASSE;SSOR, ~
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i ST. ttJC1E COUNTY, FLORIDI~
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~ This is my d~duation of Domidle a~d ptizenihip i~ th~ Stat~ of Horic
, i~ conformity wlth Ghapt~ 22~. Ssctio~ 222.17, Horlda Sfatutes.
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~ ' I wu formsrly e Ie~si nsid~?t of - 8helb~
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~nd 1~tded at 5 Nort~ Roberta Stree~t
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~ 1o and am and haw baa~ a bons fid~ ~id~M of the Stat~ of Florida ~ina _
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~ ro~ n~. snn~ ~uc~ couKr~r, ao~ow . .
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' j and this statemeot is ta be taken ~ my dederatbn pf dti~snship, actual lepsl
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~ ~ pn~t hare any pertinsnt fact:, :uch as s~le of proPerty or bu:inss~
' ~t formsr domkile, ~emoval of family to new domidle, purd~ass o+
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~ . ~tgririg childran in leL a~d 6th gradee
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I FtJRTHER GERTIFY that i will aompiy with ali o~ nqui~fs ~
t FURTHER CERTIFY tha~ 1 hsvs no intentton to ~eturn b my form
PICRCE, SAINT lUC1E COUNTY, FLORIDA, permanently.
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' '~n b and ~wb~cribsd bffon nw tfib d~y of _
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i ' ~ ROGER tO1TRAf ~
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' ? ~ a _ t~a s~G~1' . O.C. . _
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(Ti 1» ~c~wMd M d~iiealr aM! «i~~l f~d wiN~ Grrk Gn~rk C
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