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Declaration ~T~~~?~~~~~rfi~zemhip
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'It) 'rH~: STATE AND COUNTY TAX ASSESSOR,
~T. urn: COl!1'\TY, FLORIDA:
This is my declaratioll of Domictle and Citizenship in the Stale of Florida that I II m filing this day in accordance
and III l.ltllfornlltj' with Chapter 222. Section 222,17, Florida Statutes,
I \us formerly a legal residellt of
LiDIa
(City)
Ohio
State
"" I I il':,i:l,'d at
642 ,;est 3print; street
I Street and "umber)
However, I have changed my domicile
t'. "nd HilI an,l hllve h'cn a bell'a fid" resident of the Slate of Flori,la sillce
l~t
day of
icebru:...ry
i ~, 6;3 ,and I reside at
2410 S~n ~~rcus AV8
(Steet and Number)
FOHT PIERCE. !HI~T LlJCIE COUNTY, FLORIDA,
:l :d thi" "tall-mellt i" tu be taken as m)' ,Iedaration of citizenship, actual leg-Ill residence and domicile in the Slate of Florida.
(11l'l'rt LCI e any pertinent fact~, such as sale of property or business, or relinquishment of emplo)'ment
at former domicile, removal of family to new domicil', purchase of home, etc.)
lir.tf;l':"I,,~ J .::ies LeI:; Dunson in thE J~h ~r::ce
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II' I ILE~~..~NO o.ECORDED
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I ITnTHER CERTiFY that I will register at my local address when the registration books reopen, and comply
.. " ,,1:, lher requirements of a legal resident of this SUIte.
I FUP-THER CERTIFY that I have nu intention tl) (('turn to my former domicile. and I intend to remain in
1'01:'1' I'li-:I:,'j.:. ~\I:'\T LUCIE COU:'\TY, FLORIDA, perma'lently.
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~Name)
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(Address)
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__-=. D,~. . My Comrhh"sion expires
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----- ----tT~}- he (,Xt'~'utfd in dllp1hate and ori~inal filed wltlt. CIPrk Cftc'uit Co~rtJ and dup1i~ate with Tax A~or)
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