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O~ciuation o~ Domicii. and Citls~nshlp ~
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TO THE STATE AND COUNTY TAX ASSE~SQR, `
St. LtKIE COUNTY, FLORIDA:
This i: m~? dectaration of pomidl~ a~d Citiunthip in th~ Stat~ of Horida that I am Nlirp this day in aooordano~ ~~d
in aonformity wtth Chapter 222, Settion 222. i 7. Horida Statuta.
~ w.s form.r~y a ~.~a~ rossdsnr of Cb3lderaburg Alabau
(~itY) (Sta»)
and 1 rosid~d at ~7 DQSOda COU t! . . Hovwv~ 1 hav~ chan~d mY domk1l~
- (StrNt and Numbtr) ~
ro and am and have bsen a bone fids ros'~dsnt of~the Staro of Florida sinos July 1 ~y ~
, 19~, and 1 r~ide a? 1213 ~outh 2Sth Street
(Street a~+d Number)
~T ~CE, SAMlT L11~ COtlNTY, RORIDA
and this stat~rrie~t is to be taken as my dsdaratjon af atizenship, actusl lepal rasklenoe and cbmidle in ths Stat~ of Horidi.
pnsert hers a~y pertinent factt, such as sale of property or bu:iness, or mlir~qvisl+msnt of ~mployn~ent
at former domkile, removal of family to new domiak, purchase of horr~e, etc.) .
Placing child in school - Dennis Bdward Bvaas .
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FILED AND RECORD~D
~ ST. LUCIE COUNTY.~FLA.
REC10R~D V I~EO
'f~$ 27 A~I { ~ : I y
f:OG~R FOiTRaS
CLERK CIRCUIT COURT
1 RIRTHER CfitTlFlf tfiat I will aomply with all ofher requirem~nts of a Ipal rosidsnt of this Stste.
1 FURTHER CERTfFY thst i have ra intention to rotum to my forme~ domic1le, end 1 intend to remain in FORT
P~ERCE, SAINT l~1CIE COUNTY, FLORIDA, peirmane~tly.
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^`~~SMrw~i`.1o~~#CF,~bsti~bed befo?e me this 27t h day ~ Au s t ~ q 6 8.
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~ ~ Notary Pubik
gY D.C. My Gommisslon eupiras
(Ti iw ~uM~ i~ d~ awi orl~iw~i f~d wMi~ CM~Ic Ci~r.+~if CaM~. +ed d~pNWN wi1M T~c Asw~ora
~ ~o~c173 v~ $8$
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