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Declaration of Domicile and Citizenship
TU THE STATE AN1) COUNTY TAX ASSESSOR,
ST. LIICIE COUNTY, FLORIDA:
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 222.11, Florida Statutes.
North Caroline
I was formerly a legal resident of Lumberton (qty) (state)
and I resided at Route 2 BOx 4C~ However, I ha~•e changed my domicile
(Street and Number) 20th ciao of
to and am and have been a bona fide resident of the ataie ui Fi~iaiis sir.;,:
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f~ Sri lq $1_ ,and I reside .;t St • L41C1Q-- -1r6la.~~. nl-~
(Street and Numbrer3
Fort Pierce 3t . Luc ie C;,urty, Florida,
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(City )
and this statement is to be taken as rte: declaration of citizenship, actual legal residence and domicile in
the State of Florida.
former domic ley remo elltof family to new domicile,~purchase of home.:~;linquiahment of employment at
Entering one child, Durinda Louise Pait, in public school.
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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 FUR~i~riER Cr, ;,TI:^' that I ::a_'o^.~ '-^-*°^tio^- to ~-t„rn to my fnrn,er domicile, and I intend to remain
• Fort__Pierce-_ _ - .-_ _ 3t. Lncie _____ ~pnt ,Florida,
tn------- ----- - - (City) - ,~ ~]-----
permanently. _~1~c~1 - ,.?'r~~=- --~f _ -- - -
(Name)
Elbert Lee Pait
(Address )
Sworn to and aubecri¢ ~ ~befo~+e ~1ie this.. - _. - 3rf~ay of
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My Co ion ezp~i~ .:. ~~°~~~ ----------------__
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(To be a:ecnted in. dUyAStlitt and orisinal 51ed with Clerk Circuit Court, sad duplicate with Taz Assessor)
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