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10 TIIE STAIE /1ND CUUNIY T/1X /1SSlS.~OR, ~c~~~
51. tUCIE COUNYY. FIORIDA:
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This Is my detlaration of Domicile and Citizenship in tho State of florida that I am iili~g this day in atco~dance antl
in co~fo~mity with Chapter 222, 5~?ttion 2??.17, Flo~ide St~tutcs. , '
1 was tornne~ly a legal ?esident of S~ N /U~ ~
• (City) ~ (State)
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and 1 ~esided at 1.~.~~d'~' ~SL,4/V D ,f~~i/~ ~ . Howeve~ I have changed my domic.ile
' ' (St~eet a~d Number) •
to and am a~d have been a bo~a fide ~esident of the State of flo~ida since Ssea~c/l~ day of
' ~~V , 19~~, and 1 reside 'ot ' 3 '70 7 . /vo~Ti~l ~7'~siNTiC ~~v j~,_
i ~ ~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, F10RIDA ~ ~
and lhis stateme~t is to be taken as my decla~ation of citizenship, actual legal residence a~d domicile in the State of Ftorida.
Qnse~t here any peNinent fads,. such as sale of propehy or business, or relinquishment of employmerst
at forme~ domicile, removal of family to new domicile, purchase of home, etc.) _ '
Applying, for Homestead , - .
- Enterinq children in school : J f ~ ~ .
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R
Q 1?NO~~DI~ i
~ - ST. LIKIE E . `
- ~ ~ - CLERKCC
R~U1 COSIfRT -
RECO.RO VERI~IEO.~
. . • - ' - ~ . M~ 8 12 36 PN =r3
- 25~8'79
1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal ~esident of this State.
i 1 FURTHER CERTlFY that 1 have no intention to return to my former domi~ile, and I infend to remain in FORT
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~ PtERCE, SAINY WCIE COUNTY, FLORI~A, permanently. '
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:y`?• - (Name) ('~en~del
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Sworn to and subscribed befo~e me this ~ day of V i9..,2,~.
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ROGER POITRAS " ~
C!EltK CIRCWT COURT Notary Publit ~
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! ~Y D.C. My Cammission expires
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~ ~oo~ 2~3 ~~E 2~48
~ (To bo oxoculod .in durlic~lo and :~~~nal (ilud wilh Clork Clrcuit CouN, and duplicato with Tax As:ossor.)
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