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Declaration' of uonuc,re and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
~T t LUCIE
COUNTY, FLORIDA:
This is my declaration 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, Florida Statutes,
(City)
TEt~N .
(S....)
I was formerly a legal resident of
CLARKSVILLE
and I resided at
RT. 1
However, I have changed my domicile
(S.,... and NUmbe<)
to and am and have been a bona fide resident of the State of Florida since
5th
day of
JULY
. 19 61 . and I reside at
1020 S. 15th .:;t.
(S"... .nd Number)
FT. PI ERCE
ST, LUCIE
County, Florida.
(City)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State
of Florida,
(In.... he,. .ny pertinent facts, .uch .. ,.1. of proper'y or b.1tintll, or ,.Iinqul......."' of employ....... .. for..... domicile.
,_.1 of f.mily '0 new domicllt. purclwl.. of home, .'c,)
E.i:l'r~HI NG T\';O CIlILDHF..N n~ PUELIG ~CHOOLS
nux
GERRY RUTH SUITER
S~,DIA LEE SUITER
7yrs
5yrs
,.'
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FILED AND RECORDEO
IN~fFI('IA'( Jf~ BOOK
196i llUG 23 p~ 2: 2 I
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ST.JtUC:E 'COUNir',: flO~I({~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with
.11 other requirements of a legal resident of this State,
I; RJRTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in.
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"',) \, r. 'j , .", (City)
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S:-vq.:~'~,.~"~~bscribed before me this "23rd
ST. LUCIE
County, Florida,
,:A~ ^_.k&
I IN-)
GARY L. SUITER
(Address)
day of
}!JOOST
19 61
Notary Public
My Commission expires
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