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'1'O TI1l~ STA1'l: ANU ('UUN'1'Y TAX ASSI'SSOR, 2s,~041
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ST. I.U.CIC _COUN'fY; I~I.OI~II)A: ~ - ~ ~
Tl~is is my dcclaration of Uc~n~icilc an~l Citit.cnship in thc Statc of 1=lorid;~ that 1 am filin~ this day in
accordancc, and in confonnity with Scction 222.17, I~lorida Statutcs. .
, •
I~vas fornicrly a tcgai residcnt of ~ , T. % and I
- • , r) (s~ace)
~ residcd at ~ . Howcvcr, I l~avc cl~angcd my domiciic to
( eet and Number)
and am and havc bccn a bona ficlc residcnt of the Statc of 1=lorida sincc ~~y day of
, 19~ and 1 residc at ~ 9~~ -S~~ /~A/e~~s y~
(Stcect and Alumlxr)
f
~ ~ C ~ , ST . L.1~GT~ County, Florida,
t~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. , - •
(Insctl here any pertinent facls, such as sale of property or busineu, ot reiinquishmcnt of employmcnt at tormer
domitile. temoval of family to ne~v domicile. purchase ot home, ete.) ~
- ' ~ ,
Applying for homestead: . . _
~ Entering children in school : f~Q D ~ ~
~ ,~,~~ti~~ ~~-,eo,~y,~~ xEA/N~ TN v~~.
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Other: ~ ~ - ~ -
~ ~ i~iEO ~~a ~E~ort~eo . ~
E ' - ~ st ~ucr~ couMrr Fu. ~
ROGEF~ ?OsTRAS - . , -
p . - ' CLERK CidCUI? COURT . • .
~ RE~ORD YFRtF1ED-
- _ A~c 1t i 1 so. ~'T3 ~
~ ~ ~ 2b20~1 -
I FURT~iI:R CERTIFY that 1 will rcgistcr at my local address when thc rcgistration books rcopcn, and
comply with all other requircmcnts of a legat residcnt of this State. •
I rURTHER CE1tTIf=Y tl~at I have no intcntion to return to my former domicile, ancl I intcnd to remain in
~Q ~2.7` P/ ~ 2C ~ St Lucie County,
rlorida, pcrmancntly. (c~~r) ' ~ "
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~ ~•,l) ~ 1.= (Namc)
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~ :'r 1;~•._ ~ . _ f ; ~
; -z % ~ ~ ^ (Addreic)
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Swor`~i~t~ artd subs r~~ied•lt~forc mc this day of ~
- :.Q: .
~ ..}~6~~ _ n. n. ~ 3_. .
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IcOGL'R PO' TRA~; CLI:I:I: CTI:CU T COUI:T 0 R e~
BQOK 2~7 PACE ~5J1
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