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i~~cl::ra~ian oi ~os~icii2 anti Ci.:~~t
TO THc STATE At~J COUNiY TAX ASSc~SOR. 2"18416 ~
~i. IUC.t COUNTY, FlORIOA
This ~s my deciarat~on ot Dom~c+ie and Cit~zeriship in the Stare of F.ar:da that i am fiiirg tn~s day in accordance and
;n conform;ty w~th Chapter 222, Sect;on 222.17, Florida Statutas.
Deckerville D~ichi an
I was former~y a tegal resident of - - - - -
(City} (State)
3249 North Ridge Road
and i resided at - _ _ . _ _ Nowever i F:ave thanGed my oomi~ile
(Street and Number)
~o and am and have been a b~na f~de resident of the State of Florida since 8th _ _ day of
June ~9__71, and i reside at ___Rt _2 BOx _ 7150 Ssx1 Carloa
- - - - - (Streat ano Number) - - - -
FOR? PIERCE, SAINT LUCIE COUNTY, FtOQiDA
and this statem~nt is to be taken as my detlaration of citizenship, aU~a1 ~egai residence and ~omic~le in the State of Fiorida.
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R (insert here any pertinent tatts, such as sale of prope~ty or 5usir,ess, or re.;nc,;;is~hmenr oi empioyment
~ at former domici;e, remova! of family to new domici~e, purchase of home, e'c.i
~ 218416
' EstablisY:in~ reaidence ~
w fi~E~,~Ne aECOROFo
" 4T. ~UCIE COUNTY ftJ1.
:
- ROCER ~01TRAS
CIEitK GIRCUIT CObRT
ItECORO VER~FIEO~,r,.~
Nov 8 2~s PN'~.I LL~ ~
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t FiJRFFiER CE2T+FY iha~ f wi~) compiy w~fh a!1 osher requir2men~s of a iey^a; res+cient o; this ~ta:a.
1 FuRThER CE~T~FY that I have no in;ention to retum to 'my rorr;er do^~i~;i;e, and i ~~ter~ to remain in "rORT
P{ERCE, $AINT.lUCfE CG:1N~Y, FLORIDA, permanently.
~ ) ~11.
~:3 (;~;ame)
~ Dickaon b~ Decker
- `~f'%~"'-^` ~ '~_E~",^~i'~ ~
~ _
_ ~A~tD~s)
~ Theloa F. recker
: Sworn to and wbscraed before me th~s 8th day of I~IOVe?lh@r.____ , 19_~],.
- ~OG~R POtT~AS -
_ GtFRK CIRCWT ~OURT tiota: y Pub~,c
_ _ . . ~.-r -
i ,
_ By _ ` ` _ t- D.C. My Com,.;~iss:on exp;res -
(To be oxocut~d in duplicate and oric~inal fi:ed with Cterk Circuit Court, and dupiicate wit;i Tax As:vs:or.}
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