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~ 288418 . `
;,1. ll1CIE COUNIY, CIORIDl1: • ` ~
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This is my dedaralion ot pomicil~ a~d Citizensh~p in thc Sta~e ot Flo~ida thst 1 am til~ng this day in rccordanco and
in conformi~y with Cl~apte~ 222, Section 22?.17, Flarida Statutes. . ~ .
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1 W~S tOfffilNfiy a iet~al teSKief11 OI
• (Cily) . • (State)
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end I residcd at _s~[L' - . However t have changed my domiCi~e
• ' (Street and Number) ~ •
to and am and have been a. bona fide resident of the State of Florida since day of
' ~~,L~~~- , 19~, and 1 ~eside 'at ' ~ ~
- • . (Street and Number)
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EORT PIERCE, SAINT LUCIE COUNTY, FIORIDA ' '
and lhis sfatement is to be taken as my decla~ation of citize~ship, actual legal ~esidence and domicile in the State of Flo~ida.
~ ~(tnsert here any pertinent facts, such as sale of property or business, or retinquishment of employment
af former domicile, removal of family to new domicile, purchase of fiome, etc.) , .
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- ~Applyingi for Homestead . ~ _ ' .
- Entering children in school : . ~
' - - ' • ~ ~ . ~ FILEO t+h~ FECORDEO
_ . . . . _ • •ST.I~G~L CUUNTY fLA. .
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. - ROC« r"uiTi~AS -
- • - ' • CIEP.K i ':~U1T COURT . -
• . • _ RfCQR~ Y~ ! tF~EE~ . . .
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1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal ~esident of this State.
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~ t FURTHER CERTIFY that I have no intention to return to my forme~ domic~le, and 1 intend to remain in FORT
P{ERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ' .
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(Name)
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~ ~~~;;..,..:::..a. ~ ~ Address)
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~ ~f-;$viri~tn to and:s~is~rib~cf before me this day of , 19~~7" -
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~ "i , • RvG[ft~`pOl~it 4'~~ ~ ~
~ ,~tf•4 URT Notary Public ~
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D.C. My Commission cxpires
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~ • EOQK ~~IJ PAG~ 1946
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~ tro i~o oxo~~~~~ a~ ~~~r~ica~e .+nd ~••~nal (ilud wi11~ Clcik Circuif Court, and duplicato with Yax Assossor.) ,
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