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iiil~1i 16 PACE568
Declarationr. blf '~WUtll~ Aand Citizenship
_ TO THE STATE AND COUNTY TAX ASSESSOR,
~1', _ LUCIE_
_ COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the Sta'e of Florida that I am filing this day in accordlnce,
Ind in conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of
CHARLOTTE
N. C.
(City)
IS,.,,)
,..and I resided It
Rt. 5 Wilkerson Blvd.
(Stree, ....t Number)
Howev~r, I have changed my domicile
to Ind am and have been a bona fide resident of the State of Florida since
~ lltth
dlY of
AUGUST
, 19 61 , and I reside at
424 N. 4th St.
(Stree' ....t Number)
~,
FT. PIERCE
ST. LUCIE
County, Florida,
(City)
and ,his statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State
of Florida.
(1_ her. .ny perlinenr fKh, ouch .. ...~ of property M 1:.ulInau, 01 ,.Iinqui.........' of afI'lP\oynMn' .1 for..... domicile.
,_.1 of flll"'ily ro new domlclle, purcha.. of home. etc.)
ENTERING ONE CHILD IN PUBLIC SCHOOLS
ROBERT WILLIAM KIRK
g yrs
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fiLED ANO RECOROED
1~~f'F/<..!9-.( AEroA'!_BOJK
\9Ei AUG 2~ Pi-' 4: 19
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sT:"tu'ciE 'COUNl'Y:FlORIUA ~
I FURTHER CERTIFY that I will register It my local address when the registration books reopen, and comply with
.11 other requirements of a legal resident of this State,
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in_
FT. PIERCE ST. LUCIE
. . County, Florida,
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(CIty'
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$~rl to~'tubscribed before me this.
;'1''''01 I. :~,'
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(NMM)
ROBERT W. KIRK
(Addreu)
22nd
- -....-- - .-
d AUGUST 61
ayof ___________. _______0____ _... - ,19. -
:r--~Ii-
Notary Publk
D.C.
My Commission expires
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