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O~clw~ation ot Oomlail~ ar~d Citt=MShip
TO THE STAT~ AND COUNTY TAX ASSESSOR, ~
8~2 _ •
Sl. lUC1E ~OUNTY, flOR10A: f
This is my declarstion of Oomic~le a~d Citistnihip in th~ Stste of Fiorida that 1 am fil~nq this day in aco~~danoe and
~n conformity with Chapter 222. Ssctio~ 222.17. Florids Statutes.
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i was formerly a leyal ~esident of _~.$a~k---_-.,_---_---- A18. E
- (City) ~at~) ~
and 1 resided at --Rt- Howeve~ 1 have changed my domicjle ~
- (St~eat and Number)
to and am and have been a bo~a fide resident of the State of Florida since _?11a _ day of
Apz'31 19
70 . and 1 reside at ~3ilute lllaid Road
. ~Street and Number)
FORT r1~CE~ SAINT LUCIE COUNTY, RORlDA "
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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(Inse~t he~e any pertinent facts, such as sale of properey or business, or relinquishment of employment- ~ °
1
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.) ~
~ntering Carolyn Warren in the 8th grade
F~~ED AND RECOROEp ~ 4
ST. LUCIE COUNTY, ~~q; - °
~~'CORD VERIFIEQ
~ 19`7g~2
'TO SEP I A!1 10: 47 -
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' RO ;ER POITRA$
Y~~ ~
i . CLERK CIRCUIT COURT
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I FURTHER CERTIFY that 1 will oomply with all other requirements of a Is~al resider:t of thi: State. i
I FUt~THER CERTIFlf that I have no intention to return to my former domiGle, and I intend to remain in. FORT
PIERCE, SAIt~'~,~~ COUNTY, FLORIDA, permanently.
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+':d ~:F ~a ~i~ , ~ - - -
J f~ s` ~ t rren
~ , • ~dinnie Bell ~~1a
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• 'j'.::;T.r '-'~,.~:1~{,::~~ (Address) _
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,r~ let September ?0 :
Sw~orri'l~~d wbsuibed befo~e me this day of , 19 . ~
'OITR/13
CIRCU OURT Notary Public ~
8 D.C. My Commis:ion expires ~
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~Te b~ ~c~aM~d in duplicah and e~inal fil~d wNi~ Cl~rk Cirwh GuN, anel duplkatr whl~ Tax As~or.)
- BoaK186 ~2146
Na. 13
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