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v~ w~.. • _ - Decla~ation ot Domiali~ a~d Citisenshlp 133012~ ~ . ; TO THE STATE AND COUNTY TAX ASSESSOR, ~ 7 ST. LUCIE COUNTY, FIORIDA: ~ ~ ~ Thla ii my dscl~nibn of Oomldie a~d ptls~nihip in th~ Stat~ ot Florida that 1~m fill~p thia day In auoordano~ a~d f~ oonformity with Chaptsr ~~2, Sectio~ 22?.17, Nor~ Stafute~. . i w,s torme.~y a ~e~.~ re~~dsnr of White pl4ins ' N~•W Yprti . (Cih~ ~ - ,,,d ~ ro,~ 453 So Lexinqton ~ve. How.+rK 1 h.w chan~sd my domWl~ ~ (Stnef and Numb~r) b aAd ~m a~d havs besn a bona fids ~ident of the'Stat~ of Florida ~Inp Pebtuar~, ~ ti ~ - ~ - ~q 63 , ~ 1408 So 27th Street ~ (Stn~t ~~d Numbs?) lrORT MERCE, SAINT LUCiE COUNTY, ~A • . snd this :tatement I: ro be taken as rny declsratlon of dtizs~ship, ictu~l lpal retidenos and domidle in the St~t~ of HoNd+i. pnse?t here any pertinent facts, such as ~le of property or bustnsss, or relinqui:hraent bf emp{oym~?t st former do+nidle, removal of famfly to nsw domicile, purchase of ~fwrrie, ~tc.) ~ 133012 • Appl~in for homestead oOK g Fl A R-~~rd~ED 1965 fE8 -2 pM 1: 40 ~ _ ' ' ~ R06ER POITRAS. CLERI( ~ ? ' • ~ ~ ~ • ST. lUC1E C@UNTr. ftIRiDA ~ ' ' • . ! 6!'~ :r ~ , ~ ' - . t ~ ~ ~ ~ r i . . ~ O~•~~• i •f~r ` . ' ~ ' - ' • , , ' , , . . J . ~'~q~~i~~~. ~ . - • ~ ; . ~ ~ • . : i FURTHER CfRTiFY that i will cori~ply wfth dl ofhK nqui~b of a{p~l ~Id~nt af thh Sht~. { ~ . ~ ~ . ~ 1 FURTHER CERTIFY that 1 have no Intentton to retum b my formsr domW{s, aod i int~e~d to remal~ in FORT i ~ PIERCE, SAINT LUCIE COUN7Y, FLORIDA, permansntty. ~ + ~ i . { 1T ~0 . ~ . . , f'' . ; ~ ~ ~ i `i'~~~'~';,~ • ~ Maauel Gutierrez , +-''+~a1- ' . ~ ~ . • : C ~-i ~,r . . ~ ~~~5 S~ S • . ./~JJ~~~\ . rwwn wwI I~~~• ~.;~~R~~,'. j ~ ~v ~ ...•`0.if ~ : y~ ~t~ ~ ~ 2~! ~ ~ _ Februar> >q 65 ~ ROOER rOITRAf . CI~RK CfRCUR COIlRT Notary Publk ~ ti ~ ~ D:C. Mr Conxnls~b~ ~xpins . - - . ' i 1T~ ~~w~d M dnpNeal~ a~ ~ei~M~l ,wlll~ CMrk ~ar Cw~~ a~i i~e~ wM Yaot A~~,~ ~ , - ' ~ Q. ~ 0 ~334 ~ • . ,