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D~alar~tlon ot Domicil• a~d Citis~nship
TO THE STATE AND COUNTY TAX ASSESSOR, ~5i~1
ST. lUC1E COUNTY, FLORiOA:
This i: my decla~ation of Oomiciie and Citizenship in ths State of Florid~ thst 1 am filinq this d~y in scoorda~a and
in oonformify with Chapter 222. Settion 2Z2.17, Florids Stetutes.
i was formerly s leqai resid~nt of NOl~th Haveu C~III~
Kity) tSta»)
and 1 ~esided at 1355 Rtage Road . Hovwver 1 hsve chan~«! my domic~le
(Snaet and Number)
ro and am and hsve been a bo~a fids resident of the State of Florida sinos l~ diy of
oatobes 6b 3p6 weat ~rboar
, 19 , snd i resid~ at
(Straet arfd Numba) ~
FORT M~Cl, SAlNT L1lCIE COUNTY, I~LORIDA
and this staternent ls ro be taken as n~y declaratio~ of citizenship, actual ieyal resictenos and domiale in ths SMts of Hortd~.
pnsert here any pertineni facts, such as sale ot~ property or business, or relinquishmsnt of employmant
at former domicile, ~emovel of family ro new domicile, purchase of h~ome, etc.)
AQ4B.STS~AD PIT~~OSS3 .
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RECORD VER~p~, .
1~1831~~0
~t ~ 2~t i r: ao
ROGER
C~R ~T COURiR
~
' 1 R1RTl~R CEftTIFlf that i w!p aomply wilh all oths? rsquirem~nts of a le~al reside~t of this Stat~.
I FURTHER CERTIFY that I have no intention to retum to my former domi~jle, and I intend to.remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA,-permanentiy.
~ ~Ghd%~~
~ . Eleanor a. Cooper
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,.,~:,i ~~;`s. .''k'bsc~ibsd betore me t?,is 12th ~y ~ d~i. tq 6T
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~ s~'~`~tR I~OITRAf
C~K C COI~T Notary Public
BY D.C. My Commiuion expiros
- . (Ti 6~ ~ ia d~ieah and ~ fiNd wili~ Ciwk C.ina~ Cowf, ~nd drptieaN wi11~ Taoc Aw+rera
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