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Declara~ion ot Domic~le and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUC1E COUN7Y, FLORIDA: y3J~~~
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This is my declaration of Dom~cile and Citizenship in the Sta~e of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Settion 222.17, Florida Statutes.
Atbens Alabaoa
I was formerly a legal resident of _ . - _ _
lCiry) (State)
and I resided at ROUtC 7 B07f 3b . However I hbve changed my domiGil~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since N._._ _9 __-_T_ _ day of
~October 65 2720 Federal Highway
19~--- , and I reside at
. - -
(Street and Number)
FOItT PtERCE, SAINT LUCIE COUN?~, FLORfDA
and this statament is to be taken as my declaration of titizenship, actual lega! residente and domicile in the State of Fiorida.
(insert here any pertinent facts, such as sale of property or business, or relinquishment of emp!oyment
at former domidle, removal of family to new domicile, purchase of home, ettJ
F~~~~N~ RECORDED
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~ss ocr i s
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Entering Heward Clinton Rowlette 12: 33
~.3~'?'33
. R06ER `r=O;TR,~s, GIERtC .
~ ~r. LUCiE COllNTY,
~ , ' FL~RtDA
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT lUC1E COUNTY, FIORIDA, permanently.
, . . . . . . _ . _ . . . . - r ti ~ !~1(<2'Y~~
' , (Name)
, ,
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~ ~ Mrs, Jaoes Bru~mitt
~ ~ ' r}' ~i - V (Address)
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5woce~ t~_ 'a'.~ ~dbscribed before me this ~ 2S day of Oc tobe r__ , ~ q 6s
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ROGER P4ITRAS
CIERK Clit t COURT Notary Pubiic
gy U.C. My Commission expi~es
(To be exscuMd in duplicate and ori~inal filsd with Clerk Circvit Court, and sluplicwtf wiih 'fax llssass~o~.)
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