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D~cluatlo~ ot Qornlail~ a~d Citis~nship j
TO THE STATE AN~ COUNTY TAX ASSESSOR, ~
51. U1CIE COUNTY. FLORtOA: ~ ~8.~ ~ ~
This is my declaration of Oomicfle and Citise~ship in the State of Florida that 1 am filinq this day in acoordance a~d .
~n oonformity with Chapter 222, Section 222.17, Florida Statutes. ~
1 was formerly a legal reside~t of -.-_-_~L~~! _ Y~i-
(City) (State)
and 1 resided at _ E?~ .Ba1t[!~~ gtl~l~-- . However 1 have changed my domitjle
. (St~eet and Number) ~ .
ro and am and have been a liona fide resident of the State of Florida since _-__~lj~_ day of
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19 _~ptri~l Xal - B~1 ~ir ~tata~ t
- - . and I ~eside at _ 120
" - (Street and Number)
FORT ~CE, SAiNT LUCIE COUNTY, RORIDA Fort Meroe, Fla. ~
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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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) . ~
~terin~ a6ildren in pablic achool - Doosld la~, Ans~l~, Derelc D~~fa
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FILED AND RECORDED
ST. LL'CfE COUt~TY, FL.A.
" ' :r=_^Ri?(: VEr fF'~v
- . 1981E~:~ -
'TO cFo 9 AM 9: i I a
-
{:.pi:E~? ~ C~ITR~S
~ CL~RK C1RCl!IT COURT - -
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! FURTHER CERTIFY that I will aomply witfi all other rsquirements of a leyal ~esident of this. State.
1 FURTHER CERTIfY that 1 have no intention to retum to my former domiti~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ .i ~'l.c.o ~2~ ~„~Q;~/
~ (Name) Na~o~~ Da~i•
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~ . (Address) .
Sworn to and wbscribed before me this ~ day of ~~~~r , 19 T~ .
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G~T Notary Public
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By ' D.C. My Commission expires
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R~ 1y.".., iw drplical~ swd ori~wal ti~d witl~ CI«~c CJra~it Cour~, and duplleah wilb Tax Ast~or.) ~
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. ~o~K ~~6 ~ 2584 ~
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