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Declaration of Domicile and Citizenship sT. L!1CIE COUNTY. FLA.
TO THE STATE AND COUNTY TAX AS3F,3~SOR,
Saint Lucie COUNTY, FIARIDA
This is my declaration of Don4icile and Citizenship 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______-___.__gyattsvil le _
(c~a)
----- Mary_ 1_zn~ ----------------
estate)
X403 __L~ricer Driv~____________ _ - - _ However, I have changed my domicile
and I resided at.- - - - -
(street and Neulbsr) "`rin day of
to : nd am and have been a bona fide resident of the State of Florida since
„~ ~p A05 30 15th Street
~..~y ----- - -
- ------ -------------------- 19_`_'-----, and 1 rest a at.----=-----_------------- - - -
--------------------------- - --(street and Number)
Fort Pierce _---_ ______-_St.Lucie_ ____ ___-_Count;•, Florida,
----------------------------- ---------------------
c~a)
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 o1 roperty or Duaineas. or relinquishment of employment at
former domicile. removal of iatnily to new domicile. purchase o1 home, etc.)
Establishing homestead residency
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FILED AND RECOROCD 1
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I FURTHER CERTIFY that I will register at my local address when the registration tacks reopen,
and comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
• Fort Pierce 9t. Luc1e_________---- ------------_--County, Florida,
m-------------------------------------------------•
(cis) o _ n. ,, •
permanently. _~~Le-~1-- -- -- ---------------
Charles B. Kim~~~
Sworn to and aubscrlbed before me this-_-~~ ----~Y ~
Januar~_____~~~__-__, A. D. 19--b1.•
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Notary Pnblk State as )ElosTda at Ike
My Commission Jan 15 , 196 ~
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(To be executed in dupliate and osiRG-a1 Algid with G7eri1 Oli
--------------- -
------------------------
(Addreu)
a>ad dnpliate with Taz Assessor)
tinwn Woolf Ce.. Plant C1t1. Pla.
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