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Det:laration of Domicile and Citizenship T.. U:'( C ",lllj~', rL A,
TO THE STATE AND COUNTY TAX ASSESSOR,
Se.int Lucie COUNTY, FLORIDA:
This ia my declaration of Domicile and Cltizenanip in the State of Florida that I am filing this day in
ac::ordance, and in con!ormit)' witll Chapter 2~, Section 222,17, Florida Statutes.
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I was form~rly a lei'al resident of..__ . .... hictlg.o..._...14.. ...,.
(City)
..I+linois
(State)
However, I hale changed my domicile
and I reaided at 711 Di versej'..Park. \.]ay......
(Street and Number)
to and am and have been a bona fide resident of the State of Florida si~~e
21st
day of
... ____n..?>1Clr~l:1.m......----".'----'" 19..6.1, and I reside ..t ,....417 __Av.e..,.G. . ,.
(Street and Number)
Fort Pierce St. Lucie
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(Cit)' )
and this statement is to be taken as my declaratic.n of citizenship-, actual
the State of Florida.
_. ... .,., .... County, Florida,
legal residence and domicile In
,.
(lnHrt here any pertinent facts, luch u ..Ie of .properly or bUlineu, or relinqui.hment of employment at
fanner domldle, removal of family to nfW domietle. purchan of home, etc.)
Entering Sandra Kay White in the 2nd [rade
935~J7
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I FURThER CERTIFY that I will reaiater at my local addre88 when the regietration books reopen,
and comply with all other requirements of a lep.l resident of this State,
1 FURT.rlER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
1L--_.__~9.r..~_._~_i~ r c ~__________._______._._.______, .___.___.g.t_LL.u.c.i.e...__.._h.____.m.___..._.. -- County, Florida,
perIIWleDtJr. (CIt7) _..~-- rJ.Q......c:A:d.J{:m._.mm_---.-.
CT- . r (Name)
l.'irs. J.D. I',hi te
---- -- ._~----_. ---- --- - ----. -.. -- - ----- ------ - --- --- --- -- -. --- ".-. ----.----
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( Addre.. )
Sworn to and IUbKribed before me thiJ...2.9thday of ./j:~:\.\..,:: ~,;, ~i.".
-p.Ma.r~-.rr---------t A. D. 19...6J., ,'f .....:. -....
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)(.- Commtqion .._{---SIan.... ' c. 19~1 '..;;.~ t<..,... ,'( ,..'
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(To be exteated In dQPUca~ and orisbW flied with Clerk ~.~ ~~ c!llplleate with Tax AII.nor)
1Il.o- lIa..I!" c... 'sue Citl', I'la,