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Declaration of D~~~~ii~l!~~Jl~itizens~p
TO THE STATE AND COUNTY TAX ASSESSOR.
St.. I.ude COUNTY, FLORIDA:
This i.8 my deelaration of Domicile and Cith.enahip in the State of Florida that I am tUrn. this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was former~y a legal resident of.--'h'u---K1ngs..tony'__'Ontario,..'_________._' hh,__,Canac.a -----------
,(City) (State)
and I resided at 233Earl S-tr6filt-...,.-------------------h..,..'.. , "'_h' However, I have ch~ my domicile
( Street f.l1(1 Number)
to and am llnd have been l> bona fide resident of the State of Florida since ' 5th 'h"__ ,,______, day of
. April,,,, ,____' n__' l~,.5.~, and I reaide-1IL_h____J-7-2.8__S,t.---F.r.anclS.nLaIUL,---------,-,--..,-------
(Su-t and Numbe")
Ft.P ierce., ,________,_,__________________', ________uEloridauu,___________,__h__,_____,____,____,____COunty, Florida.
(City) -
and this statement is to be taken as my declaration of citizenship, actual leiSl residence and domicile in
the titate of Florida. -
(Insert here any pertinent fad,;, such as sale of property or blaineaa. or relinquiahment of employmellt at
former domicile. removal of family to nt'll' domicile, pur.:hase 01 home, etc.)
93644
FILED IIND RECORDED
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I FURTHER CERTiFY that I will register at my local address when thp- reai8tration books reopen,
and comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intentien to return to my former domicile, and I intend to remain
in ,__on.____ .Ftr. Pier4 ~il;)'------u-- -, ..m ----------------,
permanently.
___,_ ,__n_ S t..---Lucie,----, __...__,___, __,______ County. Florida,
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_~,u.-., ~ - ~,:' ~,__,________,_,___,_,__h'______.._mm_
~--? ~Name) , '
__,:rl.?~.._~_!:_,!____f!~,~,cJ,~,__!:'_~,~,L_f.~_!__~~_~E.<:_~,'_ ,Fla.
( Atldreu)
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S~IT..to tW4'lfUbscri~e-d ~fore me this_____ls.tday of
~ ) ) . ,., \.f ^ "'. ;.
",:,,":,,~'~rll_,,:,u, ',~, __,hU.____'u ..,_____,__. A D. 19______61 -
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My cOm~io~ exp~,m ______,________,___,n'm___________
(T.:> be executed in duplicate I.1ld ori~n.l filed with Clerk CIrcuit Court, llJ1d duu]i;:ate with Tax AlOIeaaor)
Ho....n SUOOIY Co,. Plant Cll)', FIR,
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