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Oeciaration ot Dom~~lle and Cltizenship 1~E~~~
1'O 7HE STA7E AND COUNTY TAX ASSESSOR,
Sl. IUCiE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship ~n the State of Florida that f am fil+ng this day in accordance and
in conformity witt~ Chapter 222, Section 222.17, Florida Statutes.
I was formerly a iegal resident ot Yingaton __Ont_ario..__ ~ana Z
(City) (Stata)
and i resided at 13~ Bexx~?. $trCCti__.___ . However I have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident af ihe State of Florida since . 2?th_ day of
OC.t_~ ~9~~._, and I reside as __1~Q~_~Q11t1L_1Qf.h ctre~•t,
~ (Street and Number)
FORT PIERCE, 5AIN? lUC1E COUNTY, FIORtDA
and this statement is to be taken as my declaration of citizenship, actual legal residsnce and demicile in the 5tate of Florida.
{Insert here any pertinent 4acts, such as sale af property or business, or relinquist~ment of employment
at former domicile, removal of family to new domicile, purchase of horne, etcJ
Alier~ R~gisteation # A 11 255 513
E~tablishin~ residenc:y
_ . _ . ~~CORDED
. . ' . ~ILED AN~ gqpK
_ , ~ • ~ _ ' ( A1 l~V`^_ - .
: . t65 ` Z ~g~ ; ~I?
_ .....r~l; ~.+.~t~J' RK
~ . . ROGE~ P`~`~thCOUN~Y.
5j~ L FL R1UA :
I FURTHER CERI'IFY that I will comply with all other requirements of a legal resident of this 5tate.
t FURTHER CERTlFY that ! have no inten±ion to return ta my former domi~ile, and I intend to remain in FOR7
- RiERCE: SAIt~7T LUCIE COUNTY, FLORIDA, pe~marentiy.
_ ~~.~.a'Y -
. (Name)
~ ~ Robert Maleq
; ~ ~ - " ` - - . .
~ ~ . (Address)
. , ~
. ' ~ . f. ' ~ e
Svtirtiln~to and subscribed before me this _?$t~ day of _'j~~~ , 19 . ~
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~ ER POiTRA5 - - - - ~
~ ~K CIitCUIY COURT Notary Public
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~ B x`~"`"~'"~' D.C. My Commission expir~s _ -
t _
~ (To be axscvted in duplieats ar~ ariginal ~elcd with Glerle Grevit Coart, snd duplitatr with Ta~e Ass~ssor.)
~ 6CGK J~~