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Declaration '~l- ~~~' ~~d Citizenship
TO THE STATE AND COUNTY ,TAX ASSESSOR,
_SAINT -LUClE..-.__COUNTY. FlOlltIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance,
and in cenformity with Chapter 222. Section 222.17, Florida Statutes.
J was formerly 3 legal resident of
SORENTO
ILL.
(City)
($I.")
and I resided at
Rt. 1
(SIr- end Numbet)
However, I have changed my domicile
to and am and h~ve been a bona fide reside~t of the State of Florida ~inca
14th
day of
AUGUST
. 19 61: and I reside at
31.5 S8J)c;lr1(ln4y~_
(SIr.., end Numbef)
FT. PIERCE (Port' St. Lucie).
...... (C~) ~
ST. LU~IE
County. Florida,
-
and this statement is to be taken a, my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(1_ ..... ."y pertinent fllds, wch .. .... of property or bwIneu. or r.llnqulahnwnt of emplo........ ., tom.r domIclle,
.-.1 of femlly to MW cIomld", ~ 01 ,-, etc.)
ENTERING TWO (2) CHILDREN IN PUBLIC SCHOOLS
ROBERT DAVID SMITH
THOMAS DALE SMITH
14 yrs
10 yrs
G f -\.' lB
FilED AND RECORDED
IN ~Fto,l" .iJr~BOOK
196\ AUG' 7 pr 12: 28
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I FURTHER CERTIFY th.t I will regilter at my local address when the reglltration bookl reopen, .nd comply with
.11 other requirements of . legal resident of thll St...,
I FURTHER CERTIFY that I have no inten~ion to retum to my former domicil., .nd I Intend to remain In______
_ 'u __ _,___,____"-Lf.l~R.Q~------ _____~__u_ ,
(CIty)
ST. LUCIE
________ --____________________,__ County. florid.,
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17th------ day of n_AllW.s.T__n_nnnu_______, 19n61__
Notary Public
My Commllllon expires ______________u___________
tie lie
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