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Declnrntion. of Domicile and CitizenshipsT, t.uciE couNTr, F~~.
TO TfiE STATE AND COUNTY TAX AS3ESSOA.
ST. LUC IE COUNTY. FIARIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.1?, Florida Statutes.
I was formerly a legal resident of ____-- TIISCAL003A -------------- - ------ --- - - ~ ---------------- ---ALABAMA----
(Gtits) (state)
and I resided at _ 3220 ThrdAT~nue_____--__- - However. I have changed my domicile
(3treet and Number) ~ - -
to and am and have been a krona fide resident of the State of Florida since 10th day of
July ~9 ~~, and I re4ide t;t 107 EastPrilna VistaHlvd. Port St
. ($treet and Number) I.ue i 8
Port Pi ar c e St .Lucie County Florida,
------------------
(City3 - -- --- --- --------- -- --
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.-
(Insert here any pertinent facts. such as sale of yroperty or business, orrelinquishment of employmaai at
former domicile. removal of famil7 to new domicile, pnrchtae o1 home, ett.)
:~~ fif ~~ nonL(1
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements of a legal resident of this State.
i r`LiATHc,n Cr.nTir Y that i havQ no iTateiation to rtdturn w :.2j fL1IIIi~r d::::li=it="..-' T i_Y_::_ :l !:i r?Ti_^ffllji
~ Fort Pierce St . Lucie County Florida,
(City) -
permanentlq.
(Name)
James B. Johnston
- --- ---(Address)
Sworn to and subscribed before me this-----23_- day of
• -
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, -: -
Notate Pdblie - orida at
... ~ g~211s~------------
My CommiB~iur , _-- : --_----- -
(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor)
~:naron 8uop1• l'o.. Plent Cilr. Fle.
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