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1C) THL• STl~IG Af~U CUUNIY inx r,:,;~ ~;oc:. - 25462'7
Sl. LUCIE COUNTY, FIORIDA: ~ - ~
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, This is my declaration of Qomicile a~d Gitizenship in tho States of Florida 1ha1 1 am filing lhis day in accorda~ce and
in con(ormity with Chapter 222, Sectio~ ?22.17, Florida Statutes. . ~ •
1 was formerly a legal resident of r~ ~ S~° (
~ . tCi~~ • tate)
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and 1 ~esided at ~ Y' . H~wever I have changed my domic.i~e
• ' (Street a~d Number) ~ • -
to and am and have been a. bone fide resident of the State of florida since day of
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' , 19..;~, and I reside 'et ~ - '
- - . (Sfreet and Num
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fORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA ' " ~
and this statement is to be taken as my declaratio~ of citizenship, actual legal residence and domicile in the State of Flo~ida.
- ~(Inserf here any pertinent facts~ such as sale of property or business, or relinquishment of employment
af former domicile, removal of family to new domicile, purchase of home, etc.) ~ , . ~
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~ - . ~Applyingi for Homestead . ~ _ _ ~ .
- Entering children in school : ~jy~g f ~ ~ ~ ~~e ~s'~ . 'Y~,~
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. ~ ~ _ . ~54~i~'7 - . _ - . : : - .
~ : FILEO AND RECOROEb - - - ' - -
. 'ST.IUCtE COUMTY FL~.- . ' . . . . '
~ . ROCEn =t~JTRAS. • . - - . - . : ' ~ .
- CLERK.C~~CU1T COURT . - ~ • _ . '
- ~ ~ • .RFCGFJ YrF ~FIE~~~,;, ~ - ~ - . ~ . '
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- . ~ • . - Mar ~1 f uo PH'.73 ~ ~ . - - . ~ . _ -
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I FURTHER CERTIFY that I witl comply with al{ other ~equirements of a legal resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently. '
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,^~C • ~ C0 ' ~ ~~~AG~I v
~ aG • J~~;; ' j,' • . (Name) _
~ ` C.i:'y`~ ~l°G.: . - " .
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~lir/Otn'Yo and subscribed before me this ~ 7 day of ~ . 1
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ROGCR POITRAS ~
CLE C CIRCUIT COURT Notary Public
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dy ~a`'~~~ D.C. My Commission cxF+.res {
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RQR~ 2~ 4 f,4n ~ ~
(To bo oxocufod an cluplicafo and ~~~:-~~~~al (ilvd wi11~ Clcrk Circuit Court, anJ du~~licato witl~ Tax Assossor.) ~
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