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Q. R.
BJC~
8
457
Declaration of Domicile and Citizenshin. LUCIE C8UN:Y\ FL^.
TO THE STAre AND COUNTY TAX ASSESSO~.
3T. LuCIE
COUNTY, FLORIDA
This is my dec:aralion of Domicile and Citizenship in the State of Florida that I am filing this day in accordance,
and in conformity with Chapter 222, Section 222,17, Floridll Stlltute~
I was formerly a legal resident of
HAi-Jl,OND
UiDIA!\A
(City!
(SI.'.)
and I res;ded at
5015
lEI! ~olumbia Ave.
(S".., .nd Number)
However, I have changed my domicile
to and am and have been a bona fide resid".!nt of the State of Florida since
15th
day of
AP}tIL
,19 61, and I reside at
1310 Atlantic Ave.
(Str~el .nd Numb.!,)
FT. PllliCE
iC'ly)
::>T. LeCIE
County, Florida,
and this statement is 10 be taken as my declllration of citizenship, actual legal residence and domicile in the Stllte
of Florida,
(lnlerf here .n)' pertinent f"crl, such II ule of property or bVline.., or relinqui,hff',C'nl of employment .1 former domKlle.
r~mov.1 of hmily 10 ...w dom;ca.. purch... of home, .Ic,)
::r:T _:~n~:G T'::U (2) CHILDflEl: It. PUBLIC SDHOOLS
'"
LA:--:n D::;" IS ILIFF
14 yrs.
T~ERY D:\'!] D ILIFF
9 yrs.
.'l · ),-.,.-,
9Lj;,,,,,,,t~
flL~ ~N~ ~ECO~DEO
I~~~BOO
t
19~1 nPR \ 9 PM 2: 26
'''C'T'''r: rlr~V r "\
i' l; (; '- ; \ r 'I t.." ..J. \. ~,r" ,
Sl, LuciE COUNTl. fLOKIOt)8.l;
I FURTHER CERTIFY thaI I will register at my local address when the registrlltion books reopen, lInd comply with
all other requirements of a legal resident of this State,
I FURTHER CERTIFY that I have no intention to return to my former domicile, and intend to remain in
1<":' 0 PI ~,;~C E
~To Lu~I~~
County, Florida.
(Cilyl
permanently
0~/Uc'>
.-b
6,
\ 'J <y/~
,--;', (-/-;:,--
(N.me)
~ARAH So II,IFF
(Add"..)
Sworn to and subscribed before me ,It-,is
19tt:
day of
.;PHI L
, 19
61
\ 'oJi~Gp~~~~~:t C1RCJ>>'COURT
By ~{"'~L,<,~!<J~ ,,"--L~;-,t!ti.-!-:..~ '
M(it~~
D,C.
~~)O~~)QLi.dtX
(10 b... ut.d in du..l;u'~ ud O';lI,n.1 fil.d with CIe,k Circuit Court, .nd dupl;ut. wilh Tu A.....o')
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