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Decla~ation ot Domicile and Citizenshlp 8~'?'3
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TO THE STATE AND COUNTY TAX ASSESSOR, . ~
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Sl, IUCtE COtlNTY, FLORIDA: '
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Thii is my dacia~ation of Domicile and Citizenship in ths St~ts of Horida that i am fillrp thts day in ~aoo?danc~ and j
in aonformlty with Chapter 222, Section 22Z.17, Flo~ida Statutes. ~ . !
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Toldeo ~~~o ~
I was formerly a leqal ~esident of
(Ciy) (State)
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and 1~ided sr ~ Bo7[ 1018'. Xalbridge Nowwer ~ hav chanqsd my don+kl~e
(Shaet and Number) ~ ~ !
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t ro and am and have been a bona fide rosident of the State of Florida sinos 13 day of ~ f
~ ` spril 6~ ~ 33C ~ Se~rre~olo -
ugh Street
~ 19 , and 1 rosids at
, _ (Straet a~d Numbsr) '
FORT MERCE, SAINT LUCIE COUNTY, RORIDA . •
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and this statement is to bs taken as my decta~stlon of dtizenship, actval lsgal r~ider~os and domidle in ths State of Horida.
(insert here any pertinent facK, wd~ a: aale of properq or bu:iness, or roiinqvi~msnt of employrt~ent
et former domidle, removal of famity to new domicile, purchase of twRis, etcJ
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Fhtering ohildren in ~th , 7th snd lOth aradee ~
Jamie 8im Hulline ~~3
ao~ie r~u.isna ~th _ Ftl A AND RECOROED ~
Katb~y Mullins lOth
D~ettvid Wayne Mullina 1Qth IN ~Q~
_ - 1964 AUG 18 PM z: 3S ~
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• ' ROGER PO(TRAS
tf~~-~:~~ ~ . S1. LUCIE COUNtY, F~C[~RK -
t , : . Li ~ OINO
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~ I FURTHER CER'TIFY that 1 will oomply witfi
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G ali other roquirements of a isga! rosident of this State.
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; I~FIJRTHER CERTIFY that 1 have no intention to roturn to my former domWle. snd'1 inlend to remaln in FORT
~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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` ~ r; f . `7~1.1 7~?~ _.c~~T,.,,
s, . ~ y~~ ' r~, ~j (Na+rfe)
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` ` • ' ~ ~ ~ 'i ~ • ; l~s (lsre ~Homer~ Mulline
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~ : Sworn ro and wbscribsd bsforo me this 18 day o~ ~u$t' •~q
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s ROOER rOtTRAS -
~ C R COURT Nbt~,r~? Pubik :
~ gy - ~ - - D C. My ~on~rr?tuio~ expin~
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~ (Te b~ ~x~cut~d tn dvplicat~ snd e~inal fll~d whb C{Klc q~uft Go~et, ~nd d~iaN w~li Tax A~era
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