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~eclaration o~ DomicE~~ an~i Ci~izer~5h~p '
To Tfi~. s~~n~~~ nr~v c'UUN7'Y ~rnx nssr:ss~ii, 2'718f 7
_ St.Luc~e~ , ~nUNTY, I~LUftI~A:
'Il?is is my dcclaratio~i of Domicilc and ('itizcnshi~~ iii th~~ Statr of Florida tl~at ! am ~li~~g this il~~y in
accordance, and in conCormity witlt Srction 222.17, 1~loricl.t Statutcs. ,
I was formerly a lrga! resid~nt of ~1a~ _ , virE-inia and 1
s----- (ci~r) (sa~~)
resided at I~a~ 1 erpGt itri vP _ . However, I have changed my domicile to
lSt~~eet and mbe_~2
~mai~.r~ ad$r•_ss FO~cx l~a McI~ean 1ia 2^101~
and a an ve cen a ona i~ residtint o~` the tate of }~lorida since 1e~ ' day ot
now
A:~ri2 , 19 ~__._3 , and 1/~r~side at ~t 2,^ll!}5 Ba~yshore Drive
(Street and Numbe~)
Ft, pierc8 St . Lucie County, Florida,
_ ~ir)
and this siatement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert hcre any pertinent facts, such as safr of proprrty or ~usinrss, or relinquithment of employment at former
domicile. trmo~al of family to ne~v domicilr, purchase of home, etc.)
Entering children i. school;~ Nomestead Exempt-ion: 1 al
ilLEO AMi! sEWROfA y~~
fT.l.i~Wf COliNTY FU-
~oc~a poR~+?s
~LERlC CiRC1iR tO~iT ,v
RfEOt+9 YFPiF~EB~.~,...,.'L
. ~l 83 ~'l~
z~sss~
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I FURTHER CERT[FY that I will register ai my local address a~hen the registration books reopen, and
comply with all other requiremeTits of a legal resident of this State. -
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I FURTHER CERTIFY that I havc no intention to return to my former domicile, and I intend to remain in
b. s St . Lucie l.~unty~
Florida, permanently. ~ (c'~r) - _
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" 'v•~'.. -Z
_1 ~ ' iL ' (Name)
; ~ r*~' ~
. ' . r~ B3yshcre Dr., Apt 2 _
i :'`r' t ~u C ~.''r -
. ~ : ~ > y. . , : (Address)
' , ''k' . • ~ ~ ;4 r't. ?i.erce, ,~15
~ S.dr.n to~and•su~s~ribcd beforc i~ic this d~y of
~%C ~ G a~~.1 ~~e t~?~ T'i M c S h e r/ o>
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; -'..,,r 1- A.D. 19 ~
ROGER P RAS, C IC CIRCUIT COURT
. - - - . ~ _ ~1S ~ ~~~-~-J 0 k .
y~ tieputy Cl.er ~ B~,i~ 222 DACE14~~
~ . (To br earculeJ in Jupl~cale anJ ~iri!•~nrl f~• 1~ci~h Clrr~ firu~il Cuur1, •rnJ Juplarle ~~i1h Tax Asuuut)
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