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Sl. WUE COUNIY~ FLOhID/1:
lhis is my dcclaratio~ o{ pomicil~ and Citizcnship in thc Slate of Florida Ihat I am (iling this day in accordantcs and
in con(ormity with Cl~apter 222, Sectio~ 222.17, Florida Statutes. . ~ .
1 was forme~l a le al resident of '
Y 9
. (City) • (State)
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end 1 resided at • . Hewever I have changed my domicile
• ' (Street and Number) •
to and am and have been a, bona tide resident of the State of Florida since ~A~~-%%LJ - day of
~ , 19.aC~, and t teside at ' ~ ~
• . (Sireet and Number)
FORT PIERCE. SAINT LUCIE COUNTY, FLORIDA ~ • '
and this statement is fo be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
~ (Insert here any pertinent faclsF such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) , .
~ Applyingi for Homestead _ ~ '
- x Entering children in school : . '
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_ . ~ - - ~ . . - . , 26 -
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• ~ • . - FILED AND RECORQEO ~ ~ .
I . • . ~ - . • ST_ LUCi£ OOllMTY F~A. .
; ' - ~ : ' 'ROCER POItRAb
f ~ ~ ' CIER~ CI~CUIT COURt . .
~ . ~ , . P.f.COR~ YER~`tE~ _
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- - Auc 21 10 49 AM'73 . ~ - .
. . - - _
I FURTHER CERTIFY that 1 wil) comply with all other requirements of a Icgal ~esident of this State.
1 FURTHER CERTIFY that I have no intention to ~eturn to my former domicile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently: ~1i9,~ L es
. ~ ~
.
. • . (Name) _
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. . (Address) ,,+~~~,,v `n ~ ~ ~ 1h'~ ~ ~
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~ Swor~ to and subscribed before mc this day of •i 8~9~
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ROGCR PO{TRAS " ~
CLCI:K GRCUIT COURT Notary Public '•,,1jy''•~s", 0~`~~
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~y D.C. l~Ay Commission ~~Y Pn~~ ~r ne ~ r^•~t
O R GEP:~R :L It.~Uitl+1 E UiZD::R~ilRl R.
_ BoaK 217 ~ 24 ~ - ~ ~
w~ (To bo azocuted an duplicalo ancl ~-•~~nal (il~d wilh Clcrk Circuit Court, a~~ ~p wit r Tax Assossor 2• 197d 1
• GENERAL 1NSUfiA~ICE l:~G~R:'li
tT~~S, INC„ ~
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