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D~ctaration ot Domi~il• and Citiz~nshlp 1'~3'746
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Tt7 THE STATE AND COUNTY TAX ASSESSOR. ~
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Sj. IUCiE COUNTY, FIORIDA: ~
This is my detlantior~ of Oanicile and Ctizenship in tM State of Norida that 1 am filing this day in aooorda~ and
in conformity with Chap»r 222, Sectio~ 222.17, florida Statutes: ,
1 was forme~ly a le~al rosident of Auan¢ols pen~d
(City) (Sta»)
and 1 rosid~sd at gd 4- ~ountaln Top . How.ver I haw chsn~d my domkiM
(Street and N~rmbsr) _
ro~~d sm and have been a bona fids rosident of the Staro of Florida since -~5 day of
July , 19~$, and 1 reside at 835 Airoea Blvd _
(Street a~d Number)
l~ORT S~ANrT WGE COUNTY, FIORiDA
and this :tatement is to be taken as my decia~ation of citizenship, actusl le~al residenoe and domicile in the State of Horida.
pn~t here a~y pertinent facts, such as sale of property or businexs. or relinqui~ment of employment ~
at former domicile, removal of family to new domidle, purchase of home, ett.)
Latabliehing Reeidenae for Homeetead purposes
~i~EO~aNQ RECORO~T
gY. I.UCIE COUN'~Y .
RECOR0~3~F~~~ ~
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~ +6.q ,fAp 10 PM 2 : Oq
ROGER r'OITRAS ~
CLERK CIRCUIT COURT~
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~ 1 RJRTHER ~9tTIFY that 1 will aomply wHh all otF~ roquirerr~nts of s Ispsl rosident of thk State.
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I fURTHER CERTIFY that i have no intention b return ro my former domiCile, and I intend to ramain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently.
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835 Aiross Blvd ~ ' -
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Sworn ro and wbsuibsd t»fon me this lOth ~y ~ Jau ~9 b 9:
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CIRp1R COIIRT NOtiry PtJblk ` - i ,
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