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Declaration of Domicile ~
TO THE STATE AND COUNTY TA% ASSI:S3OR, ,
ST LIICIE (,OUp'1"Y~ FLORIDA:
This is my declaration of Domicile and Citizenship in th
accordance, and in conformity with Chapter 222, Section 22.
I was formerly a legal resident of-__; _---Seel;le_________________
s sit
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and 1 resided at. 1~1~ti3 .- 35it1L_~ita: -1~--------•-------- - -
(3treet and Number) .
to and am and have been a bona Rde resident of the State
---J----- --- - - __- 19---~G, and I reside at------~
P'T. PIERCE ------------- , -------3T. - ~
----------- ---- -------------------- -----------------------
icity)
and this statement is to be taken as my declaration of citiz
the State of Florida.
(Insert bare any pertinent facts, such as sale of yropertyy or
former domicils. removal of famil7 to new domicile. pnrchsse
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and comply with all other requirements of a legal resiuc;,t o;
I FURTHER CERTIFY that I have ao intention to rata
in------------- - F~ .---PIERCE, - - -- -- ---- _ ST
(City)
permanently.
~.
S'aloi~j,''{o,altd~ictd~ecribed before me this_._S,~yt~day of
..
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ROGER ~OI~RAS-CLERK CIRCUIT. OURT __
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(To be executed in duplidte and
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led with G1erk C