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260462
~~~ta~a~ian ~or~ic~le ~~~d ~itiz~~s~~~
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,
TO THE STATE AND COUNTY TAX ASSESSOR, ~
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-u-~'-~~ COUNTY; FLORIDA: ~ ~ ~ '
This is my dcclaration oP Domicite and Citizenship in the State of Florida ihat 1 am feling this day in
accordancc, and in contormity with Section 222.17, Florida Statutes. ~
1 was formerly a lega! resident of , a'' and I
4 Y ~ .te) .
resided at . ~ti. However, I have changed my domicite to
cs~ro~~ .~a r?~me«~ / ~,y
and and have been a bona fide resident af the State of Florida since day of
, 19~= and 1 reside at 6~'~~ ^-'i~u~ti
(saee~.~a N~mMr)
' ~.~~;UL.C~C/ „ ~~..l.l~l~Cli
County, Florida,
~dir)
and this statement is to be taken as my declaration of citizenship, actual legal tesidence and domicile in the State
of Florida. .
•(Insert hcre any pcrtinent fsets, such u sale of property or business. or relinquishmeat ot employment at tormer
domic~7e. removal oi family to new domicite. pwchase of home. ete.) ~
~ Applying •for horr~estead ~ . ,
~ Entering children in school
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. ~ ~ 9 ~ 260462
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LLD AND RtCpADfO ~
~ LUCIE COUNTY f~A. •
ilOCER PG~TRAS
CL~RK C~"CtitT COURT - _
' _ REC!? p VCk~=tE~J~,~,,.~„r,~
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. I~uc 3 1 i lz AM'73
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` I FURTHER CERTIFY tfiat I will register at my local address when the registration books reopen, and
` comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I havc no intention to return to my former domicile, and I intend to remain in
~'c.~'~'~..~~ _ -~~~,u-c,c~C' , Count ,
Y
Flpri~2t; ~c~rr)anently. (c~~r)
~'v" ti ' • \
'~'jC_...~~ ;r~ ~ll~~.~//vW~
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{ ~I~ ~~Y,~ ' . ~ v ,
J~~• ' ' lt • (Address)
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~Siyotlr to a~ia subscribcd bcfore me il~is day of
' /Qt~c- . A. D. 19 73
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' ROGER ITRAS, C1.~RK CIRCUIT COURT o k
g0U11 ~ rAf.? 3~Q
I3y cLUC,~ ~ D . C .
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