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Declaration at Dom-icil~ '~nd Cit;Zcnship
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TO TIlE STATE ,\:-;n COC:-':TY TAX ASSESSOJ~,
31'. IXCII: COt::-':TY, FLOJUDA:
This is my declarati)n of Domicile and Citizenship in t'". State of Flori'h that I am filing this day in accordance
a~.d iI; c.lIl{orlllity wIlh Chapter 222, Section 222.17, Florida St;,t"tes,
. Niles
1 was formerly a legal resIdent of_______ ____.~ ,. ____________
[City]
Ohio
Stat::-
,md 1 rcidc'd at
1628 Hobbins Ave.
[Street and Number]
IIowever, I have changed my domicile
April
1st
-125 E.ArborJ[V~
Port St. Lucie
I reside at ______ '~______._
[Street and Number]
day of
to and am and have been a b:ma fide res dent of the State of Florida since
'9 63
1 __ ___, and
FORT PIERCE, SA1:,T LUCIE COUNTY, FLORIDA,
ar,d this state:nC'lIt i:; to b~ takcn as my d~c1aration of citi;:enship. !lct:lal legal residell,'c aliI domicile in the Stolte of Florida,
(1l'spr( I:ere any per-tine::t Lvt" sU':'h as s11~ of prcperty or business, or relilO(juish:nent of emploY:llent
at fermer domicile, rC:1,0\'al of family to new domi'Ile pHdnse of home, etc,]
Entering
Toni Votino in the 9th grado
"
Fred Votino in the 8th grade
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I Fl'RTHER CF.RTIFY that I will register at my lac;!; a:ldrc35 when the reg-istratinn b:ok3 reope:1. and comply
with n!l other re'luire:11ents of a le;al resident of this State.
r I-TRTI!ER CI.:r,TIFY that I h3\'C nJ i:',tention to ret:.lrn to my former do:nicile, and I intend to r.:':nain in
FORT PIERCE, SAI~T LUCIE COUNT~, FLORIDA,
permanently,
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F:rAd Vot
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[Address]
Sworn to and sub3cribed before: me this__3rd
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. __n_, 19.._63
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()J ,\'J'"L ",.y :, !\:otary PublIc
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D,C.- '~ ' My CommissFdIl 'expires _'o____ ______
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[To be ,,:H'<,uted In duplicate and orlglnll fiI ~(1 with cterj(''f)lrcnij' 08urt, nnd duplicate with Tax As'iessor]
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