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. (~c:c:l;~rc ~ic>~~ af f:ut;ti~:il~ .~ti;i Ci:i::c:~i::l~tt~ `
lU 111G Sfl~1L /1NU CUUNiY T/~?( n.~::l',:~C~K, ~V~6
51, IUCIE COUNTY, FIORIUl1:
lhis 1• my daclorelion ol Oomicltn end Cltfzunsliip In tho Sto~o of Florida tl~al 1 em (iling thi~ dsy in eccordance snd ;
in contormiiy with Chap~ar 22Z~ Soction 222.17~ Floride S~etulos. . ~ ~
I w~t tormorly s lo~el rosident o( . _~c
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end I ~otidod at ._w.~.. `e 7 However 1 havs cha~qed my domitile
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~o and em ~~d hsve been s bona fide ~osident o~ ~ho Stats oi Flo~ida since _ ~ dey of
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' ~ , 191~., •~d 1 rosids '~1 ' ~ Q ~ ~ ~ ~ i ~ ~ ~ ~ 1~ P _ ~ ~
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FORT PIERCE, SAINT LUCI@ COUNTY, ~LORIOA ~
end tht• NNement is to be teken a: my docleretion of ci~izenshtp, ectuel le9sl ~esidence snd domicile in the Ste~s of Florida.
pniert here eny pertinent fscli.:uch es sale of proporty or buslneis, or roltnquishment of employment
~t fo~msr domicile, removat of famlly to new domicile, pu~cheas of home, etc.) ~
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~ Applyinq~ for Homestead 25~8~ '
- Enterinq children in school ;~l ~ i~~ ~
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~ I FURTHER CL-RTIFY thet I will comply with ell other requlrements of a lepal reaide~t of thi~ Stat~.
I FURTHER CERTIFY thet 1 have no intentio~ to ~eturn to my former doml~ils, end I intend to remein in FORt
PIERCE, SAINT LUCIE• COUNTY, FIORIDA, permenently. '
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.,~tn~to'endwbscribed bofore mo this dey of ~ ~ ~
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RO(iER POITRAS
C Iti~ CIttCUIT COURT Notory Pubilc
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(~y _ ~ _ My Commiasion oxplro~
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53 .
+ (1o bo oKOtulod jn tlupliuto and ~~~~~ul lilud wlll~ Clork Circuh Courl, ai.J Juplica~o wilh t~x Atiwswr.)
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