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TU THC STAIE AND COURt1Y iI~X n.,,t.~.,Uk, ~rv1~s5
51. LUCIE COUNTY, fLORIDA: ,
This is my declaration of Oomicile and Citizenship in thc State of Fiorida tt~at I am filinq this day in a;tordante ancl /
~n conformity with Chapter 222, Srsction 212.17, florida Statutes.
1 wa: formerly a lega! resident of _1_~~~e . Q,~_
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end 1 resided at ,.~Q_O . Nowever 1 have dtsr?ged my domiCjk
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to and am and have been a bona fide resident of the State of fforida since ~-1 ~ day pf
• __h.~t. 1r , 19_L?!', end I reside st W e. . ~ V t 4 ~t_
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FORT PIERCE, SAINT LUCIE COUNTY, FLOttIDA
and this statement is to be taken es my declaration of citiunship, actual legal residence snd domicik in the Stale of Florida. -
(Insert here any pertinent facts, such as sale of property or business, or relinqvishment of employmeM
at former dorriicile, removal of family to new domicile, purchase of horne, etc.)
Applying, for Homestead ~ ! ,
- Entering children in school : ~
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1 FURTHER CER7lFY that ! wiH comply with a{I other requiremenls of a legal resident of thi: Stafa.
I fURTHER CERTIFY that I have no intention to return to my former domit~le, and t iMend to remain in f.OR'T
1~IERCE, SAINT LUCIE COUNTY, FLORIDA, permaneMly. ~ ( FM+MA "~,ju~,~E~f ~ s~^
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Sworn to and subscribed before me this • day of , ~q,~
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ROGER POtTRAS 1~
CLERK CIRCUIT COURT ary PuWit
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(To be oxewlod in duplics~~ and origi~~a! fil~d witk Uer1c Gicu;t Gwit, ind d~pfiuf~ witb Tax Assessorl
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