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Declaratio~ o! Domicile and Citisenship
TO THE STI?TE AND COUNTY TAX ASSESSOR, ~~~W~~
Sl. WCIE COUNTY. fIORtDA: ~
This is m~? detl~rafion of Oomicile and Cititenship in the State of Horida~that I am filinq thit day in atcord~nos and
;n oonformity with Chapter 224, Section 222.17, Flaida Statutes.
I wss fotmeriy a leqal ~esidant of Ambrose ~ ~ Ge.
(Ciy) (Stste) .
and I rosided at Rt t . However 1 have chanQed my domidle
(St~aet and Number)
ro and am and have been a bo~a fide resident of the State of Flaida since 24th day o~ ~
~ ~anaury ,~q 65, a~ ~ reside at .!tt 4 BOx 369
(Street a~d Number)
FORT NERC~, SAINT LllCIE COUNTY. RORIDA
and this statement is to be taken as my declaration of citizenship, actualleQel residenoe and domicile in the Stete of Horida.
pnsert here any pertinsnt fads, such as sale of property or busineu, or relinquishment of employment
at former domiaile, removal of fam;ly to new domicile, purchass of home, etc.)
Jame: ~s c~ming to live witn his sister Mrs Leonard I.owe
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Fl~ED AHD RECOR
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: ' ~ : v _ ROGER POITRAS CIERK
. - . ~ ~ S1. LUCIE COUl~T~!, Ft,DRIOA
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1 FURTHER CHtT1Flf that i wlll aomply with all other requirsmsnh of a Is~al rosident of tfiis State. i
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1 FURTHER CERTIFY that 1 have no intention to .return to my former domicjle, and 1 intend to remain in fORT ;
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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t. ~ _ ~ - , ~ . _ `~Zn,n ~~'/1 C" ;
~~L ~y`~ . . . . `v(' , ~ _'yrj ii~~L~~.
: - ~ James Lovea Giiner - ;
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~=:;C~,;;- .-~v ~istera name~~ross) j
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''''~~:.Swor'!,"fo~ind,wbscr~bsd before me ~his 25th ~Y of Jan. tq `
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R~~ rORRAS 1
CL~RK qRCUtT.COURT Notary Publk ~
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gY..~_. D.C. My G~mmission expiros-
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Qe b~ ~ancvl~d te d~pNc~N awd ai~in~l f~d wfll~ C{~Ic CMarh CaKt, and d~ia~N wbb Tax As~r~ora j
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