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TO 'rUE STATE AND COUNTY TAX A83l'..ssO~'
51', LUCIE COUN'l'Y, FLORIDA:
"
This ilS Dl)' declaration of Domicile al'd CitlMHhlp in the State of Florida that 1 am fiUllIr tU1a day in acco~
snrl in conformity with Chapter 222, ~t1on 222.17, Florida Statutes.
1 was formerly a lepl realdent of
Rawleigh
(City)
North Caro1in8
....... State
anti I resided at
920 Kent Rood
. However, I have cban~ my domieUe
(Slr~t and Number) .
to and am and hr.ve ken a ~ona fide resident C1f thE State of Florida since --1st
eLly 01 .-
],~bruary
517 Beach Court
19_-Aa and 1 realde at
(Steet and Number)
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FonT PIERCE, SAINT LUCIB COUNTY, FLORIDA,
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and this "tatement ill .to be taken .. my declaraUo'l of clUl.alship, actual legal relidence and domicile in the Btaw ~ Florida.
....
(Insert here any pertinent facta, such &I lI&le of Prowt1 or bwin.eas, or relinquiahment of employment
at fornler domicile, ~move.l of family to new domiell!. pureW'.l of home, etc.)
establishing resldency
11.~
f\LEO !\NO RECnRGf.O
I =iii'..~.\ o.rCiN BOOK
\N~~-
\~b1 fEe \ 8 ~l'\ 9: 56
l' R A. S Cltt\~
RO~U~~( PC~~Nn I fUH\\O} I .1/
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I FURTHER CERTIFY that I will !'9iilter at my loeal addre.. whtn the ~tn.Uon book. reopen, and comply
with nil 'other re{!,'!rement.s of a lei") resident of this State.
i FURTHER CERTIFY that I have no Intention to return to my former domicIle, and I intend to yem.t.in in
FORT PIERCE, SAINT LUCIE COUNTY,
FLORIDA. permanentlt.
'-/ /)
--+ 1.-' --h.; (1 --/ // /! , ---------
__ / ,( '--__no '-'1.0""'\ / J / . .I,/~CC:/.: '
- Fleming J. Pr~~;) ,/ )
(Addr6fi)
S...-orn to nnd suhllcribed Wore me this
18th
Feb.
,19
63
day c.f
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(To be u&Cl1te-d
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~-/l ~ ... '"" ~\1(.. ", "" ,'" Notary Public
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'tj;~;:ii?]!:~:ff.;~r .
ill dap)kate IUl4I oriPa&I fl1c4 11'''~~~~~~'~ nplkaie witia Tu M_tv.)
. ~ ~? :~~~....~.~.: -"~' .~
ROGER i'OITRAS
" e).ERX CIRCUIT ,~OURT
./ # ~
By ./f.:', -/,~~ L~' ~'O~_~ _/c
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