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% Declaratlon ot Don~icile a~d Citisenship
.i4~~~'72
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUGIE COUNTY, FIORIDA:
Thia is my declaration of Oomicile and Citizenship in the State of Florids that I am filing this day in acoo~danos and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
t was formerly a tegal resider~t of i....~~. r~s..
(Ciy) (State)
a' i~as~-~ a~ Z However I have chanyed my domir~jte
(Street and Number)
to and am and have baen a bona fide ~esident of the Stata of Florida since 2~~- day of
Ln~st , 19~~, and I ~eside at YnTa~?~R~aa
(Sheet and Number)
POIET PIERCE, SAINT LtJC1E COUNT'1f, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here ar~y pertinent fads, such as sale of property o~ business, or relinquishment of employment
at former domicile. ~emoval of family to new domicile, purchase of home, elc.)
~tering 9t~~e in the 11th gr4d•
=~nt in th~ 8th grade ANp q,~~~R
M s~'f 1t1~~~ ~p~ OED
• J~iir~~ in t~he 2nd grad• RF~~R~ VER(FjEp~*~4.
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! I FURTHER CERTIFY that 1 will comply with all other raquirements of a laga! resident of this State.
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; 1 FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and t intend to remain in FORT
f
F PlERCE, SAINT LUCIE COUNTY, FL4RIDA, permane~tly.
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',UC~~~hd subscribed before me this 26th day of Jn~at ,~9_(~.
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~ ~ " ROGER POITRAS
~ ClRCU11 C RT Notary Public
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~ By D.C. My Commission expires
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~ Ro b~ uacut~d in duplicat~ and ori~insl fil~d wi~h q~k Grcuh Court, snd duplicaf~ with Tsx Ass~stor.)
~ aooK 153 381
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