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Deele...--atiOl1. of Domicilo and CitDenabiD
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TO 'lIH~ STATE AND COUN'fY TAX ASSESSOR,
ST. LuCIE COUNTY, FLORIDA:
Thi~ is my declaration of Domicile and Cltlaenablp In the State of Florida that I am fHine this day in accordance
9nd in ,onrormity with Chapter 222, Section ::22.17, Florida Statute:!.
I was formerly a legal resident of
Tuscaloosa
Ala.
(City)
8~w
;1n 1 I T\.."i.!el; at'
2424rl N~nth St.East
(Street and Number)
1st
. day of
However, I bave cb~nged my domicile
t.> and om and hove been a b:):la ride resident of the Stnt~ 9f Florida since
February
63 l3l0 Atlantic/ave
IIJ_---' and I realde at
(Steet and Number)
FOHT PIERCE. SAI~T LUCIE COUNTY, FLORIDA,
9!1<1 this statl'mcnt is to be taken as my declaration of citizenship, !lctual legal residence and domiciIe in the State of Florida.
(In'<crt here any pertinent facts, such as sale cf property or bu~lneaa, or rellnquiahment of employment
at (ormH domidle, remo\'81 of family to new domlcle, purchaae of hOll'e, etc.)
Ente1'in6 h~ctry Kuthe1'ine Collins and Dorothy Marie Collina
in J1', Ho.:;h
11.334.1.
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ROGE? PC~~~\ig'Sf~~.,~\~~j) , ALii
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J FURTHER CERTIFY that I wi1\ register at my local address
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when the regiatraUon books reopen, and eoml'ly
with all "ther rcquirementM or a legal resident of t,!1ia State.
I FURTHER CERTIFY that I have no intention to return to my former domiclk, .nd I intend to remain in
FOHT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
'1;;'~ ;h-,. (!~..//J~~..J
(Name)
Virginia Mae Collins
(AddreB3)
:~',;(1111 Ir, an,l Subfcribed befure me this 21
Feb.
I 19--6..1..--
day of
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CI"I he executed in dupllce1e and odgina' (jJ~ with <..'1"",,, 'cll:cwt ~ a:JiCi' uupU(&te with Tax ~)
HOGER POITRAS
~I.F.R[{ ClRrUIT COURT
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