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Dec~aration of por~nicile and Gitizenship
TO Tlit: STAT~ AND COUNTY TAX ASSL.SSOR, 24~~IK~i1
St. Lucie
_ _ COUNTY, FLOR~DA:
TF~is is nly declaralioi3 of Uomirilc and Citizen~hip in the St:~t~ of
I=lorida tfiat 1~m tiling this day in
accor~ancr, and in conl'ormity with Sc~tion ~??.17, Florida Statutcs.
l was formerly a Icgal residrnt ot' ~~/~!9~'!.N a~zd 1
- - (C;Ir) lSiate)
r~sided at a___~~?~_v Y~~___~~ . Howc:ver, 1 have changed my domicile to
(St~rrt and Numbrr)
and am ar~d have 1xe~~ a bona fde ,resid~nt of di~ State oi Florida sincc day of
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~'_C~L~~1~_._ . 19 _ 2 ~ :111d 1 ~esi(~t :lI v• s • S~/~ _ ~L~1/~ 1~ '"~INfN/L'l~N jz//K/Q .
~ (Strcet and Numbet)
_~dk_f__ ~ f r~lJCl S%.~ C/ T=-
_ ~ ~ County, Florida,
(c~~r )
and ti~is stat~mcnt is to be tal:~~n as my dectaration of citizenship, actual legal residence and domieile in the State
ot' Florida.
(Insrr? herr any prrtinrnt facts, such xs salr of propert~ or husinzss, or rrlinyuishment of tmploymeot at forme~
~micilr, remoral of family ~o new dom~cil~, purchax ot hume, rtc.)
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fce 1~ 4 26 PN '13
24~'721
1 FURTNER CERTIFY tnat 1~vill register at my Ioral address when the crgistration books reo~en, and
comply with .ill other reqairements of a I~gal resident of this State.
I FURTHER CERT[Fl` that 1 ha~•c no intention to return to my fornier domicile, and 1 intend to mmain in
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u~ _ y..~~~ ~ /~t-« ~ .c~ . County.
Floric~;~:-~~~ri~ •~~t'y. ~c«y~---------------- _ - ~ -
~ v C
_ ; .
r,s`r ~?z ~c~, ~ . .~C,~ ~~~c-~~~------------
. ~ ~ ~ ~ ~ ; ~ ~ _ . (1\ame) -
- john C . Furnis s
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: i • . i t ' ~.,r ; - Esina. ~~Fum~is~--------------------
- . ' ~ (Aaaress~
: • ' ' Y i i
~ ' ' ~ S , 2 H
Si"vo~-i~~tcav~il~~~ssiibed before me this da~r of
~ ebruar`y ~ 73 ~
- - A_D. 19--
ROGER POITRAS, CLERK CIRCUIT C(~URT ST LUCIE COUNT , FLA.
l ` Notary Public Stafe of Florida at Large '
_$~t,_ _ s~t_!~!/ ,~~~71 C~9L~
; ~eputy Clerk
(To be rxecutrJ in duplicale and on~cinal iiled with Clrrk Circuit Court. and Juplicate with Ta: Assessor)
do~K~11 PA~~1358 , . . _ _
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