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Declaration of D rllicile and Citizenship
~7. i'."~!E C^~JNT`', ALA.
TO TIIE STATE A.,TD (';OUAT1'Y TAX ASS,SSOR,
3T. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship In the Slate of Florida that I am fang this day !n accordance
and in conformity with Chapter 222, Section 222.17, Florida Statutes-
New York City
I w•as !ormerly a legal resident of -
[Chy]
quarters 12 B Gov. Island
and I resided at.----
[Street and Number]
to and am and have been a bona fide resident of the State of Florida since
Nov e::.ber
19_62 and I reside at
N,Y.
State
However, I have charged my domicile
19 t day of
1106 Chipola Rd.
[Street and Number]
FORT PIIItCE, SAINT LUCIF COUNTY, FLORIDA,
and this statement is to be taken es my d°claration of citizenship, actual legal residence and domicile in the State of Florida.
[Insert here any pertinent facts. such as s31~ of property or business, or relinquishment of employme%it
at former domicile, removal of family to new domicile purchase of home, etc•]
Establishing residency
in the process of building his home
l~ O'~2~3.r
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FIL .A~Q Reso~d~~00K
tN_ qua
1962 ~OV 2~ QM I1: t 4
R~GEIE CO N1Y SfIOR OA
ST, LUC
~~
I FURTHER CERTIFY that I will register at my local address when tl~e registration books reopen, and 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 I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, perman°ntly. //_
Name]
Edward C. Gorsuch
[Address]
Sworn to and subscribed before me thiQ 28~ ~~iay of Noye~Tlber ~ 19 6'
` y ,.
P.OGER POITRAS p~ .. _~--• ------ --- - ---- ---
CLF.RIi CIRCU T COURT .• ~~ ~ ' ~ •. - Notary Pul=lie
3y -__-+ • D.C! - + "`i'Iy Comrriission expires
_- ~ ,~
[To be Executed in dupl!eate and originsl filtd wit~•Ca`Ib~ii` C~'etkft` Cosu•t, and dupUcate with Taz Assessor]