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O~cluaNor~ of O~omictlt aed C1tisMShip
TO TNE STATE AND COl1NTY TI?X ASSESSOR. 203~9
Sl. lUC1E COUNTY, RORIDA:
This is my deda~ation of ~omiciie and C~ti~ship in th~ Stat~ of Horida that 1 un+ filin~ this doy in ~ooord~no~ and
in aonformity with CMptar 222. Section 2?2.17, Horida StatuMs.
1 was formerly a legal resident of ~
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and 1 resided at S~ ~~•~T ~.l . Fbwevsr 1 have chan~sd my domic~le
(Street a~d Number)
ro and am and have been a bo~s fide resident of the State of Florida sinoe ~ J^ day of
_ , 19~ snd 1 roside at c~ .
(Strset a Number) / / •
~J' c c-~
FORT ~IERCE, SAMIT LUCIE COUNTY, RORDA
and this statement is to be taken as my dedaration of atinenship, actual legal res'~de+xe and domiale in the State of Florida.
pnsert here a~y pertinent facts, such as sale of property or busineu, or relinquishment of employme~t
at former domicile, remova! of family to new domicik, purchase of home, etc.) •
6nt,1.2 C~t~
111tfl 9f COR6~1
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CLEAt CIR~INT OOli~j
yERtftEO ~K
Ju~ 11 M sz AM'11
E 203209
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~ I FURTHER CERTIFY thsf I will oomply witfi all ott~ roquirornents of a lepal reside~t of this State.
~
i Fuan~Ea c.~anFlr ~r i~~ no ~nr~,t~«, ro return to my former domic~le, and I intend to remain in FORT ~
PIERCE, SAINT UlCIE COUNTY, FIORI~A, permanentfy.- ~
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~ ,t, muis CGt rk P;s i
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~ (Address) ,
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~ q.and wbsuibed before me this -Z day of , i9~C.~
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~ ~ ~ V'.'e~ 1~Oti~/ PN~IC
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• ~ = _ ~ D.C. My Gommission expins
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