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D~~cl~ratl+~re c~t i~omlCil~ andl C~tia~nship
Tt~ TNE.STAi'E AND C4UNTY YAX ASSESSQR, , ~~0$8?~'
S'f. IUCiE COUNTY, FIORiDA:
j This is my decla~ation of ~omicile and Citizenshtp in the Stata of Florlda that I em filing this day in aaordante and
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. t~ co~fo~miy with Chepter 722, Section 2~2.17, Fiotida Stetutes. ~
t was formerly a legal resident of Caro~ina B~elCh N,,~;ar+
~ (City) . (State) ~
and I ~esidad at Ge~ ~D~~ , Howeva~: `~ave changed my domicJte
~ (Street and Number)
ro and am and have been a bona flde roatdent of tha State of florida itnce ?th day of
" IVOVCmbe~ ~ ~9 64 and I reside at 9~_.._~l.1.;~. T
_ (Streat a~d Numbar)
fORT PIERC~, SAINT LUCIE COUNTY, FtORlOA
and ihis statament is to be taker~ as my declaration of citizenship, actuei leyai residence and ckmiclle in the Staro of Fldrida.
(insert here any pertinent facts, such as sale of properry o~ businass, or ratinquithmenP of emptoyment '
at former domtcile, remova) of family to new domicile, purchase of fiome, etc.)
,
Bstablisha.ng residency
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IL At~D RECORDED ~,,,:,~:~,TM;~~;;;;~;.~;;:
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$j, LUCIE :.'~'.`'o'~``
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~ • 1 HJRTHER CERTIFY that 1 wil) oompiy with all ather ~equirementa of s Ipa) rostd~nt of this St~h. :
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~ 1 FllRTHER CERT(FY that I heve no intention ro return t~ my former damic~le?, and 1~ntand to remaln in fORT
PIERCE, SAINT LUCIE C~UNTY, FLORIDA, permanentiy.
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~j`„.`.~~ and subsertbad bafore me thi: day of oYembeP 19 6'4'.
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. ROGER ~OiTRAS ~ ~
K CIRCU~COtMT Notary Aubli: •
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(To b~ ~x~c~t~d in dupttcah ae~el aigiasi flt~d wiTh C1Kic ~ Co~rrt, aetid duplie~o w~i~ T~oc A~aora .
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