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. " ~ec~a~at~on ot Domtcil• and Cltisenship 132453
TO TME STATE /WO COUNTY TAX ASSESSOR,' - ~
ST. LtJC1E COUNTY, FIORIDA: . ~ .
Thts is my dsdsrattor~ of Domicile a~d Citlzenslrtp in th~ Stit~ of Florld~ th~t 1 am filinp this d~y ia aooordano~ and
in. oonformity with Chapte? ~~Z. S~cNo~ 222.17. NorWa 5tatut~s. • ~
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1 wai Forrr~srly a ieqal r~~t o~ J~~a ' N. ~Y, ~
(City) • ~Stab) r
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' u+d i ns~dsd ~t 92-Ob 173sd St. ' H~vK 1 haw dN~q~d my domi~l~
- (SnNt a~d Numbsr)
b a~d am and haw bsan a bona fid~ resld~nt of the Stat~ of Florida sino~ 28t21
~ No~iembes ~ 19b4 142 Lucero Dr.
, and i rosid~ e1
~ (Stnef and NumbK)
~ ~ORT M~CE. SAINT tNC1E COUNTY, RORIDA ~ .
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and this ~tatement is to bs teken es my declaration of citi:enahip, actual lopa! rettderxs ind domidl~ In th~ Stat~ of Horid~.
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(I~ssrt hsr~ any pe~tinent facts, such as sale of property or budnsa, or rolinqoish~t'of unplo~ynwnt
at former domidis, removal of famlly to new domkile, purchass of homs, etc.) .
Piling for homestead purposes ~
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C,E COUNT'l . f 101t1~ .,J ••..n...,.. '~~r
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~ FurtT~R c~tnFlr thn ~ wu~ oompl~, w~th ar~ r.q~,~?«n«~+:~ of . Ipal t~ald~nt of ihl. st.a.
1 fURTHER CERTIFY that f have ~o intar»ion b retum to rr~y forn~ domic~le, and 1 intend to ransin tn fOt~T
WERCE, SAINT LUCIE COUNTY, FLORIDA, psrman~ntly. -
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