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Declaration of DoTri c ~e anT~-F~-"~ifisenship
TO THE STATE AND COUNTY TAX ASSFiS3OR,
3T . LIIC IE OOUNT'Y, FLORIDA
This is my declaration of Domicile and Citizenahin in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of_-_____..---X4CKYILI.S-_,I,pf~_-_LgI,AI~Il,_._~ib'~~O,a$____--_____
(Cita) (State)
anri i waitipri gt lt'!7 ~~'CM~1~--~q~T ~tw_-------- ---- _- However, !:A:'~ =1*.sIig~ed ;;,v ~n~intlp
-.--- _ °---=-- (Street sad Number) .._~. .
to and am and have been a bona fide resident of the State of Florida since . -~i~[ ~i~t$ __ _ --_-_ day of
_ _ _____ __Novelaber __ 19g~__-, and I reside ut.--__380 Csleatia Court,__Port__3t._Lnole
(Street and xnmMr)
!'ort Pieroe _-------------St.__Luaie_______-____---_-- _ County Florida,
(city)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida. -
(Insert here say pertinent facts. such as sale o1 yroperty or business, or relinquishment of employment at
former domicile, removal of family to new domicile, purchase of .dome. etc.)
GK~'ER OFOPT fi~I,F IArTTctEST IIv r vi~icl~.
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I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
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il(IU ~VIIt~IY iYllrtt Ail Vl11Ci 1Ct~Uil G!!'lCl1W V• O ic~aa 1~31iicii~ VL ba:w .,i:.. ~:..
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
• FORT PIERCE- ---------------------------- --- -----------~T--•LUCIE~--------------------- - -_--------- -County, Florida,
m------------- - - - - - -
- - ~ - ~ l~ /'---- -
~ (City)
permanently. ~-- ~ ~~~ ~' -. "
-- ------------------------------- -------- ------------- ----------------
(Naaoey
- Veronica C. Cassidy
(Address)
Sworn to and subsc~ibed'1#fytore me thia_-_l,k. _-- day of
,, ~. __`
----~TB,D aB~X~~ `,:~------ - . •. , -----. A. D. 19__41.
1 ~{.~`'; - `ham ~ CfG7r.UL
---- --------- o - --~-- -~-.-1--~ -----------------------
taryz b1lA'Stata ~ si at Lase
., ; ,., .; - 1163----------------_
My Commiasio>Y ~e._..(.
(To be ezeeutc~,ul~lp~i ' to and orisinal 81ed with Clerk Circuit Court, and duplicate with Tes Assessor)
Rnwnn BuoDlr Ib.. Flent 1117. Fla.