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I.t155H
Declaration of Domicile and CitizenshiF
TO TIlE STATE AND COUNTY 'fAX ASSESSOR.
O.R:
efj'~~
60 F~E 229
:iT, LUCIE COUNTY. FLORIDA:
ST. LUClf C;UNTY. rL~:
This is my declaration of Domicile and Citizenship in the Stn:e of Florhln that I am filing thig day in 8cconlancc
and in conformity with Chapter 222, Section 222,17. Florida Statutes,
, Hortord
I was formerly a legal resident of__~ ---- --
[City]
_~il..QhJaaUa___
State
and I resided at
~o Chat.on Road
However.
have chanl;ed my domicile
[Street and Num~r]
.. 3
to and am and ha\'e been a bona fide resident of the State of Floi-ida since -----------
day of
.Apr1l
19_e~, and I reside at _ ____!.1_~_~~_~6!~_ATenue
[Street and Nu.mber]
[o'ORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
ar:d this state:nent is to be taken asmy declaration of citizenship, acturll kgal residence awl domicile in the Strite of Florida,
[Insert here any pertine::t fa~ts. such as s1k of property or business, or relinquishment of employment
at former dom[cile, remo\'al of family te new domi ('ill' 'p:lrcl:rlse of home, etc,]
to
MoT1ng lu12 Chipola Boa4
t 'tl\5~)8
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I FURTHER CERTIFY that I will register at my local aJdress when th.' reg:strati'~n b~'oks reope:]. and comply
with all other re:iuireme:Jts of a le<;al resident of this State,
I FUHTllER Cr:;nTIFY that I hrlve n') i:1tention to return to my former do:nicile, and I intend to r.':n:lin in
FORT .IV-'tft6!.~S~lNT'\LUCIE COUNTY, FLORIDA, permanently,
J. I} J ~ r." I:'.... . "'l fA, (J/
' , i'v~/~ LZIZL (,;~(/~~L~~~__
~' . j./ [:-;ame]
,-
MrS. John W. V1cker.
'..' ".
....'
1;;"
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C' , i ~'\ ' .
Sworn to an'd s~bscribed ~fore me this__ t5
[Address]
__u_Ap~ n___
&3
I~L ___
,~:iay of
3y _
ROG :~R POITRAS
CLl:i')j (',I~lTIT CU'.TT
~/ I~.c_-&{f __ ________ __
--_ D,C,
:,-,!'1 Co:n:-:lis,ion e",pires ---- ---------,---
>';otary Public
[To be (','\:('('uted In dllpl1~ate and orlRln:l1 fIIe'l with Clerk Clr('ult Court. nnd dllplkate with Tax ,\s<;essorl