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D~lauratlon ot Iar+o?,~l~~t~ and citls.~nsArp ~
~ 1344.82
ro 1'N~ STAT@ ANd OO~IiNTY TI~X ASSES.SGrR, .
ST. l1,IC1~ OCIMVYY. ~tOMOA:
TMb i~ n~y drd~r~tior? of t?omicih and Gtir~r+sF?ip in th~ Stats of Flo'ida thae i am Htinq ~1?is day in ~ooondino~ and
M aonfiorrNly wiMu q~r 71"~, Srrttbn Z?~.17, porida StawMs.
1 wrs tormKly a ipsl r~i~dent af ~~1ulolt~ NOtth CasoliM
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'~rees~n! Ai?r. E
and 1 r~1d~d at " _ . t~owsv+r 1 hsve chan~d my clomidl~
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b~d ann and h~w bs~n a bona fide rosicwnt of the Ststr of .~torida sinos dfy af !
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~ Jtsl~ 19b3 , and ~ r~kk at 1129 Glab Dr.
{5tn~t ar+d NumbK) ~
~ ro~t wa~. s~nrt wt~~ couivnr, aoaow
" and this staNn+iernt is to be teken a~ my deKlaration of citi~c~sr?ship. ar~uai leqal resider?a +r~rd domidf~ i~ the Stair of Ho~tda.
pnsKt h~n anY p~rtinent fatts, such as sale of proparty w busines~, or rolir~qciishmeat of ~mpla~rm~n! ~
~t formK domkile, rortwval of femily to new domicile, purcfiase of h~rro, et~.) ".,,,p,~,, ~
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i fURTflER C~itT1fY tfiat l wilt oomply wfth atl other requ(nerNnh o~ a ipal ratdsnt of thi~ Stat~.
. 1 FURTHER CERTI'fY~that 1 hava no intention to return to rny fonnar domWlt, and I intertid to remain in FORT
PtERCE, SAfN'f t.t1CtE COUN7Y, H.O~tfDA, perm,anentty. ;
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