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Decl~~
ation o~ ~?or~:~~~~~ ~r~~ C3~i~~r~~~ 26~8~6
1 t~ "t'I tt: STAT~ ANU ('OUN7'Y 1'A\ ASSl~SSOIt,
St.Lucie ~ ;
_ ~_COUN7'Y, I~LOltll)A: ~
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"Tl~is is my dcclaratiun of Damicilc and C'itir.cnsl~ip in lhc St;itc of florida ih:il ! am filin~; this ~I;~y in , s
~i~cor~lance, and in conformity with Section 2?2.17, Hlorida Statutes. ' ~
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I~vas formcrty a icgai residrnt of ~~~~P~~~~~ }
_ (c~~r) ' ~ (s~.to~ and 1 ~
r~~~idcd at v~ ~~~UC .~fowcvcr, 1 have changcd my domicilc to
(St~cet and Number)
~~?~d am and have been a bona fide resident oi' tlie Statc of Florida since day of ;
~ O ~ ~ c~ , 19~~., and 1 /res dc at ~U ~A~ K ~i4 ~ll ~ cJC _ F
(Street an Numbet)
/r ~ /C~t~r~ /~i4~ ~ St. Lucie County, Florida,
( ~~r)
a»ci this statement is to be taken as my deciaration of citi~ensliip, actual legal residence and domicile in the State •
of Ftorida. • i
(I~se~t here any pertinent tacts, such as sale ot proprriy or business, or ~elinquishmeot of employment at tormer
domicile. temov~l oi family to aew domicile, purchase of home, etc.)
Entering children in school:
/ o~ y ~9 i?~? f~ .c%t/i4 . .
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_ ~ ~ 26'78'76 ~
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R4CEF. f~ITp4S jic/~ ;
CL[RK C:::CUIt COURT ~~.J' ~
, _ RFrn~n yf.Pi<<ER
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~ No~ l 9 s~ AM'73 ~
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1 FURTHER CERTIFY that I will rcgister at my 1oca1 address when the registration books reopen, and :
comply with all othcr requirements of a legat residcnt of this State.
I FURTHER CERTIFY that I have nv iniention to return to my former domicile, and I intend to remain in R
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f- /c oeC c- ~ S. Lucie , County, ~
Fforida, permanently. (c`cr) • . ~ ~~g ~yN~ ; ~
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twaa~~~ ~ ~
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Sworn to and ubscribed before t~e this ~ day of ;{a
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~~~I/~' ~ :i{~~~. ~ . . i d
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l~~E' ` ~ . A.D. 19 73 ~
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R ` RA~;'r~ERK CIRCUIT COURT ' _ ~ ~
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-=~'~~s'-~~~:~-;~ ~ ~eputy~Ier~ N_4~ . . j
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1b~~te~~dln duplicale anJ uri~inrl fJ.d w•ilh ('1«k Circuit Coutl. and Juptic~te wilh Tna Assrssor) .
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