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Decloration o~ ~[~rt~~ci~'e and Citizenship
TU THE STATE ANll COUNTY TAX ASSESSOR,
St . Lucie COUNTY. FLORIDA
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformit~• with Chapter 222, Section 222.17, Flurida Statutes.
I was formerly a legal resident of-_.. DQanhasset.. L.. dI, - Nw~._XQrk._- ____ _ .___ __ _
(City) (Sate)
3 __ 27__... _..,._ T 1....... l...wr.nr~ .~ .7n•r.•nila
and 1 resided at GU .70ULit ~r1YB - iiuncvci, a uw~a. ~.uwug~.u .+i~ v.+++•:v...,
(Street and Number)
to anal am and have been a bona fide resident of tie State of Florida since AL1gl1Qt laf~yzadzY
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- -- -- ------ ------ ----- - _ . 19.6Q , and I reside i;c _ _ 1831__wyoming aYe._ \-yraage . __.
(Street and Number)
___Blossom Estates) Ft. Pierce, -__-_. - ___ _ _ - St.Lucie _ 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 any pertinent facia, such as sale of roperty or business. or relinQuiehment o1 employment at
former domicile, removal of family to new domicile, purchase of Lome. eft.)
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FI! r nF~n FE~C?QED
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I FURTHER CERTIFY that 1 will register at my local address when the registration ~tidoksreopen,
and comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to re±~~rn *^ w for.^.:ar ao:::ieile, snd 1 i^.te^~~ to :err:i::
• Ft. P ere e _ St. Lucie __ -_-County, Florida,
~----------------- -- -------------- -- i - - - - ---------- ---- ------------. - --
(City) r
permanently. ~-'jL~C-~~ .) , ~ .,l--i~ 6~.GL~
Donald S. Pered~i~)
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'~'~•, •••••~~- . ~~'~. 1931 owing A4id~liilPierce,l~le.
~Sidotir to, ~'1~ubecribed before me this.-3~~_-.day of
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• ~ .•-_-~~~~- --$Y , A D 198
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~' ~ OI ,; CLS~ CIRCUIT COURT
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(To be ezeeuted in duplicate and original Aled witL Clerk Cirenit Court. and duplicate with Taz Assessor)
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