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~~a.ia~at~a~ ~t aa~nl~~l~ ~nd Clt~~~r~~h:p .
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA:
This ~s my declaration of Damiciie and Citizensh~p in fhe State of Florida that 1 am filing this day ?n accordance and
~n conformity with Chapter 222, ~ection ?22.17, Florida Statutes.
I was formerly a legal resident of _ D@tTOlt D~1CYllgBri
(Ciry) - - (State) ~
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and I resided at 4909 BY'BdeII However 1 have changed my domiGle '
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 23rd _ . day of
September 7c~ i«~ £ay~iond Av~. _ ~
. , 19_ _ , and I reside at
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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 empioyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
pI,pCING ~~[YZ.~]CH~CZI~ CHII,D IN SCHOO~r~~EO AND RECOROEO'
ST. LUCIE COUN~Y. F~A. ~
Rebekak Stewart 11 yrs. ~'`R!~~`Fn '
198~3t),i
'?0 SEP 25 ~+1 9: 36
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~;0~,= i'OtTRAS ~
CLERK CIRCUIT COURT ~
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I FURTHER CERTIFY that I will compfy with all ather requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to ret~r~ to my former domicjle, and I intend to remain in FORT
FIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
- _ L,~E~~ ' - - -
+ (Name) RObes e
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.~~~v~`.z e • 1223 Raymond, Ft. Pierce, Fla. ~
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Ls''~.'~~, : :f~.4 25th Septedber 70 ;
` ..u. od subscribed before me this day of - _ 19 - ~
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= ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
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By ~~~1~ / --~_.~L.~t D.C. My Commiss~on expires -
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(To b~ ~x~cut~d in duplicat~ and oriyinal ~il~d with G{frk Grcuit Courf, and dupliut~ with Tax Ass~ssor.)
BOOx 187 PAGf
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