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Declaration of Domicile and Citizenship Bo~K 2b PA~480
$T• ~~~~~ COl1NTY~ FIA..
TO THE STATE AND COUNTY TAX ASSESSOR,
St. ~c_i e -COUNTY, FLORIDA: -
This is my declaration of Domicile end Citizenship in the State of Florida that I am filing this day in accordance,
Section 222.17, Florida Statutes.
and in conformity with Chapter 222,
_ Tom! 8-Giver- ---- . --Iia~--_derasX.__---
'1 was formerly a legal resident of - _ . _ - - - - - - - - - - ~) tsta•)
Box 134 Kettle Creek Road, However, I have changed my domicile
Silva ton,_N.gJ•
- -r - ------ --- -- - --
and I resided at - _ .. _. _ - ~~ a+d ~tt«) - - - - -
- -- - ----- --- ------ -day of
to and am and have been a bona fide resident of the State of Florida sinoe_-- . - --
---- --- S2ctQber--- - - -- -- - - - , 19 61 _, and I reside at _3.~4-_ ~ri~i~~la_~~r~~t - ------:------=
Fort Pierce ~ county, Fltxida,
- ---------$t.--Lucia--- ----- --- -
-.-- - -- - - -- - - - - - - tci+r)
and this statement is to bs taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
~~wt~r~ a 6ttaMn•., a r•lirquMMn^t °~ ""Pt°r"~'u ~ ~"~ donticiM.
(iMNt tIK. •IIuy YLL~~..'•^'^^ faCN~r MKt1 M~,MyM ~Of ~OpM~Y
f'M110'1Ht Ot tw,~' tO BMW tttltalit~t•, ~ t1011M, t~l
1014'71
FllEO AND RECORD ~~K
1561 JAN -2 ~ 1I : 30
ROGER CDUNR~ SflOR10
1. LUCIE P
S
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I FURTHER CERTIFY Chet I will register at my bul address when the registration books reopen, and oorr-ply with
all other requirements of a Isgal resident of this State.
1 FURTHER CERTIFY that I haw no intention to returr- to my fornner domidle, and I intend to remain in_____-
-----$#.+---Lucia--- ------------- County, Florida,
----- - -
-----F-~~- ert.8-~ ------------
permanently.
N ~ I ~subacribed before me this -
S~cn. '~1. , .
(Frances K. yefort)
--~.1,4--G~rsi~+ ~~4~trsat---------------
.Fort Pierce, Fla.
- danv~Y --------------. 19_2---
2ud----- d+r ~ -------
j • =~~,5~ •. ~l ~, - , CLERK CIRCUIT COURT ----
-----------------
-------------- Notary Public
. ~ ~J ,
•~ ~ ~. ~ o ' _ ~ __ D.C. My Commiuion expires ---------------------------
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