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<<.~~?,~»~ ~ . 258339
LUGE C.uUtd 1 Y, i tUi:IL}!~: ~
ihis is my cleclaration ol Domicilc and Citir~~mhip in thc Stalc of Floricla that I am fili~~g this day in atcorclancc anc!
in conlorm;ly with Chapter ??2, Sedion ?22.17, Flo~ida Statutes. , '
1 was formcrly a lcyal rr.sident ot •_~o`'~ ~-Q~--~-o-~~-y
~ (City) - ' (State)
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end I resided at 3.L_ ~ ~ ~ . Howeve~ ! have changed my domicile
' ' . (Street and Number)
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to and am and have becn a bona fide ~esident of the State of Florida since / day of
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, 19~, and I reside 'at ~ ~ . ~ P-~-~.
~ . ' -7 (Slreef and Number)
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F~RT PlERCE, SAINT LUGIE COUNTY, FLORIDA ~ - •
and this statement is to be taken as my declaratio~ of citizenship, actual legal residence and domicile in 1F?e State of Florida,
~ (lnsert here any pertinent facts,. such as sate of property or business, or relinquishment of employment
af forme~ domicile, ~emoval of famiiy to new domicile, purchase of home, etc.) , '
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~ Applying~ for Homestead _ •
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. - - ~ ' ROCEF. i1RA= ~ -
- ~ - CLERK C~RCi1R COUIt'T
~ : ' ` - : ' RECORD Vf P.tFtEO,..,~ -
~ - ~ - - ~ .b~. 6 2 s3 P!!'73 ~ .
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" - - ~ 258.339 - ~ .
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F
i 1 FURTHER CERTIFY that I will comply with all ofher requiremenfs ef a legal resident of this State.
f .
E 1 FURTHER CERTfFY fhat I have no intention to return to my former domi~ile, and 1 intend to remain in FORY
~ PIERCE, SAINT LUCIE COUNTY, ftORIDA, permanently. ' J~ j ~
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F . .
; • . ~ (Name) .
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° Sn~~jtrta'ancx~b'~istribed before this day of _ ~q~~ .
e - . ~
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ROGCR POITRAS '
~ CLCltlt Ui:CUIT COURT Notary Public
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s ~ y ( ~ C~ ' .
D.C. My Commis :ion cxpi~es
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~ - ~ _ _ ~ 21s~ 28?
~ ~OOK Y~IGE
(To I~e axoculed •in duplicate i~. -•~nal (il~d wilh Ueik Circuif Cou~l, an~f duplicato wilh Tax Assassor.)
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