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'I~O'TI1L• STATI: AD~11) COUN'fY TAX ~1SSI'SSOIt, ~
261993 ,
ST. LUCIE ____~:OUN'fY; ~LOItIDA: ~ ~
Tl~is is my dcclaration of Domicilc and Citir.cnship in thc Statc of l~loricla tLi:t 1 am filing this day in
accordancc, and in confonnity wilh Scctio~~ 222.17, l~lorida Statutcs. ,
I was tom~crly a lcg71 residcnt ot A~~ e~~ ~ 1 1~=- • and I
~ (ci~yj (sute)
residcd at ~ v~~ V' ~ c.v ~ G'~ °L- Howcvcr, I havc changed my domicilc to
(Slretl and Nu~nbct) ~ ~
aa~d am and have been a bona fidc residcnt oP tl~c Statc of Clorida since ~ day of
, ~
- ~._1 , 19_ and I reside at ~ ° ~ ~ ~ ~ v' £ w ~ o ~ _
(St[cet and Numt;cr)
f- o ~ 7' ~ r' C~ , ST . LUCIE _ County, Florida,
(~~r)
and this statement is to bc taken as my declaration of citizenship, actuai lcgal residence ancl domicile in the State
of rlorida. • •
(Inse~t here any pertinent facls. such as sale of properly or business, or relinyuishment of employment at former
domicile. remaval of tamily to new domicile. purchase of home. etc.)
Applying for homestead : . . . .
~ Entering children in school 9~
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o ~
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• . _SL~~ c~~.~ ~ ~ _ ~u - }~2~,~.`.
Other: ~ _ -
' . ~ ' ~~1'
fli#8 ~M8 FE~ ~ - -
' _ ST_ l.tiGE GOiiliiY ' -
~ : ~ ROCER ~Bt~RAS ~
~ CIER* CIf:CU1T COYAT
~ AECOR01?ER:F~ED
~ ~ ~ ~ ~ 08 ~'~3
- ~ ~ ~ 261393
I FURTI-~rR CERTIt=Y that I wili register at my local address wl~cn the rcgistration books rcopcn, anc~
comply with all otl~cr rcc~uircments of a lcgal residcnt of this Statc.
I FURTHCR CERTIFY that I have no intention to return to my tormer domicile, and I intend to remain in
~ Ur-t ~7 r C t St•• Lucie COUIlt
, . Y.
I~lorida, pcrmancntly. cc''''~ -
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:'c = ~ % E ~ , a ~ ~
~.1` . vV" •.~~G'- ~i~~ (Namt) _
~..~~a. ~ . . • ~~:-f;~-t ,
y y~'-:. ~I~~~'~_~ Mt. ~ ~ y
_ fj~ - , u' ? ~ G S t_ L ~ LC..tJr~
N : ~ - c : ~1 ~ ~ } (AdJres.~)
~s ' .~y;r`.''~ i: t:~:
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• c:a" . .
~~'~fit t~ts~~iz bcCorc mc ihis ~
y~day of
, ` ~ .
- . A.I). 19--~
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i~C)G1sIt POITi;/1S, CI.i:1:1C CJItCiII' COUI:T dC~K~~~
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