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Sl . tUC1E COUNi Y, FlO1:IDA: ~ '
This is my declara~ion ol Uomicilc and Cilize~~ship in thc State of Florida that t am (ili~c~ this day ir~ actorclance and
in contormity with Chaptc~ 222, Sedion 222.17, Flo~ida Statutcs. , ,
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1 was forme~ly a legal ~esidenf of • ' ~'y~~~`~~'~`~ ~ ~
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end I rss ded at ~ . However 1 have changed my domicile
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to and am and have been a, bo~a fide ~esident af the State of Florida since day of
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~ ~ ~ ' ` , 19,~, and t ~eside et '
' (Stre i and umbe~J
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FORT PIERCE, SAtNT LUCIE GOUNTY, FLORIDA ~ ~ •
and Ihis statement is to be taken as my decla~ation of citizenship, actual tegal residence and domicite in the State of Flotida.
- -(t~sert here any pertine~t facts~ such as sale of property or business, or ~elinquishment of employment
at fo~mer domicile, removal of famity to new domicile, purchase of home, etc.) . .
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~ ~Applying; for Homestead _ ~ ~ ~ . -
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Entering children in school : i/~-~ ~ ~ ~ . . .
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- . ' ~ . : . ~ c~cEa ~Mt.~fco+toEO - . _ . - : -
. ' . . % . . ST: LUCIE w7UNTlf FLA.._ ' . _ ~ -
. . . ~ . . RBCEh ?G'•TRAS ~ _ . -
. - - • . - C~ERK Cl~:~Ulf COUR7 : . . . - -
• . - - °cC PQ vE_t~•::;E3._..~_~ _ -
' - - - . ~ ~ Niu 18 : 12~ a2 PH'~3 . - : : ~ ~
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f 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of lhis State.
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! f fURTHER CERTIFY that 1 have no intention to return to my former domic,ile, and I intend to remain in FORT
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; PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently.
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~ ' ;~j~~-l~•~~~'•,, ' = . (Name) -
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~ ,,Syvp~n•fo'~¢3db~chilied before me this day of , ~q~
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~ CR POITRAS ' ~
€ E(tK CIRCUIT OURT Nota~y Public
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~ ~Y- l~~~ D.C. My Commission expires
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; (To Go oxoeulad an elupiiealc and ~-•~%na1 (il~d w' ~ ireuit C~~ncl du ~lieato w+tle Yax Assossor.)
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