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aala~ation o~ Oomlatl~ a~d Citls~nship
TO THE Si~1TE ANO COUNTII TAX ASSESSOR. ~
Sl. U1CIE COUNTY. PtORID/1:
This is my cl~claration of Oomicil~ and Citiuriship In tM S~~t~ of Florida that I~n~ filin~ this day in aooord~na and
in oonformity with ChaptK 224. S~ction 224.17, florida StNuhs. ~
I wss forme~ly a le~ai resid~nt of Bellegl8de Florids
(~ity) _ ~1ab~
and I msided at - 1534 ~1..W. F P18CS . 1~avwvK I have than~sd my domWl~
(Sh~t and Number)
ro a~d am and have been a bons fide rosident of the StaN o# Florida sinoe 18 t day of
July_ , 19 70 , and 1 rosicl~ at 702 8am~ie Ct:
~ ~ - . (SNeet and Num~r)
FORT MERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is ro be taken as my decla~ation of c~ti=en~ip, actual le9al residenos and dorr?idla in the Sta» of Fbrida.
pnsert here any pertinent fatts, such as sale of property or business, or rolinquishment of emptoyment
at former domiciie, mmoval of family to new dariale, pu~chsse of horr~e, etc.)
~ ANO RECORDEO
_ S': LUCIE COUNTY. F~A.
`''E:~~RD V~RIFtEp
~ 'l0 A!~C 14 , l9`~
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- ~:o~,~~ ~OIT,~AS
~~ERK CIRCUIT'"COURT ~
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t 1 RJRTHER CERTIFY that 1 will oomply with all otF~ r~quirenwnb of a Ipal r~tid~nt of thb StaN.
I fURTHER CERTIFY that I have no intention fo retum to my fomner dornitils, and 1 intend to remain in FOitT
PlERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ThOm88 8. BLirtOII
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Sworn to and subsuibed before rn~ this 14 th ~y ~ AugLis t 19 70 .
;t~:~..::d.
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; V : G ~T Notary Publk
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gy T: ~ D.C. My Commission ~xpirp
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Re-'~j' - «i~~al HI~ wNM G«k praiM C«r~, a~i ii~licalr wNb Tnc A~.J
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~ ~,~_:,:+;,~,t,,~~~ s~x186 ~~1225
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