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51. IUCIE COUN1 Y~ FLORIUA: ~
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lhis is my declaialion ot Domicile a~d Citizenship in the State of Flo~ida ti~at 1 am iiling this day in acto~dante and ~
~n conformity with Chapter 22?, Settion ?22.17, Florida Statutes. ~
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I was formerly a leyal ~esident of (!~~~QL,,(~~~`-
(City) (State)
and 1 resided at -.~!'~~~l1 However 1 have chan ed m domi 'le
9 Y G
~ (Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since -_L~~~ day of
- , 19 and 1 reside ~at ~~J!/Jl/XLl.CCli C:- C. • /~;I?:(. ol~Ulf~~.L
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaratio~ of citizenship, actuat legal residence and domicile in the State of Florida,
(Insert here any pertinent facts,. such as sale of property or business, or relinquishment of employment
at former domic+le, removal of family to hew domicile, purchase of home, etc.)
Applying, for Homestead ~ ~ .
~ Entering children in school :
f~«o ~?~rn R~coRO~o ~
~ sT. LUC1;. CDUNTY FLL
, • RL~CFK ~~tTRAS
~
CtERK L;F ~:1~t cOURT ,
Pfr1Rr, Yc~. =1tt?
- Ar~ i0 10 0~ AN'13 ~
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2s1ss3
t FURTHER CERTIFY that I will comply with all other ~equiremenis of a legal resident of this State.
1 FURTHER CERTIFY that I have no +ntention to return to my former domiCile, and I infend to remain in FORT
r'iERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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•~tnmri~.to ar~d subscriE~ed before me this day of ,)q~,
ROGER POItRAS
CLERK CIRCUIT COURT Notary Public
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~Y - _ D.C. My Commission cxpires
_ aa~~ zl~ vACt 24 "
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(To be oxowtcd ~n duplicato anJ ori~inal hlcJ wilh Ucrk Circuit Cuu~t, and duplicato wilh Tax Aasossor.)
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