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~ Declaration ot Domicile and Citisenship :
TO THE STATE AN~ COUNTY TAX ASSESSOR, ~
51. LU~IE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Flc~ida that 1 am filing this day in actordance and
im m~formity with Chapter 222, Section 222.17, Florida Statutes. •
1 was formerly a legal resident of LlfIIi101L-_ LfiglA„~ -
(City) (StaM)
and I resided at However I have chanyed my domiCl~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida si~ce F'ebrnal'i? 9 day of
. 19~g-, a~d I reside at T~s*+~~l.~~ost St ~,nsia
~ (Sireet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fb~ida.
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(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Placing child in public school - Aathony J. Lewis
- F~~E~ '~N~ RECOROED
S ~ LUCI~ rpUNTY, FLA.
. ~fl 1/: 1 rl
. ~899~~~.,
'r a FEB I 7 10 : 49
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c' E.~~ ~c;f;CL'tT COURT
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
~ 1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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F.
~ (Name) ~bert Lewie
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(Address)
,tf
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~ Swprn.to and Subsuibed before me this 17 day of Febivary , i9_3Q
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~ RO~i~~ PQtT~'-~
CL,~,RK;SIRCII~ COURT Notary Public
~ By ' 7~~ZC ~ D.C. My Commission expires
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F~: (To b~.+~x~cuhd in duplicaN snd orisinal fil~d with Cl~rlc Cirwit Court, snd dupliuf~ with Tax Ass~or.)
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~ No. 13
y ~OOK 1~~ PA~E~~
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