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Decla~ation ot Domicile and Cittzenship ~
132951
TO THE STATE AND COUNTY TAX ASSESSOR.
51. WCIE COUNTY, FlOR10A: '
This is my declsratlon of Domicile and Gitizenthip i~ ths State of Horida Mat 1~m fllinp this day in aoootda~os and •
in conformity with Chapte~ 2Z2. Section 2?2.17, Flortds Statertes.
1 was formeny a legal resident of Chic aqo ~ I11.
(Giry) (Sta»)
end 1 resided at 522 N Map1e Mt. Prospect
. However 1 have chanpsd my domki~e
' (St~eet and Number)
~ to and am and have been a bona fids reside~t of the Staro of Florida :i~os Sth day of
. r
JHly , l9 64. ar~d I ~ssids at 302 Olive Ave. Kiver Park _
(Street and Number)
FORT PIERCE~ SAINT LUCtE COUNTY, RORIDA •
and this statement is to be taken as my•declaration of citizenship, actualle~al ~esidenos and domidle In ths Staro of Horid i
pnsert nere any pcninent facts, such as sale of property or business, or ~elinquishment bf employmsnt . ~
at former domiciis, removal of family to new domicile, pu~chase of har~s, en.2 i
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Establishing residency Fl i
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- 196SF~B AM 9: 43
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v`= sv~.. ~~;G St. IuCIE cOUN~r, F~p~
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I RJRTHER CERTIFY that 1 will aanply with ~II other nquir~n~h of a leya( rosids~t of fhis St~t~.
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- ~ 1 FURTHER CERTIFY that i ha~ve no intention to retum to my formsr, idle, end I inter~d to remain in FORT
PIERCE, SAINT LU~IE COUNTY, FLORI~A, permanently. ~
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~worn to and subxribsd before me this - ISt ,~y of _ - Febru ry , 19~.. ;
ROOER rO1TRAS ;
CIRCUIT COURT - p~~k .
gy ~"`'~w~ D C. My Ca~xniulon ~x ~
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ffo b~ ~acw~d 1e duplieah snd ert91w~1 til~d wiN~ CMrlt CMr,irl~. C~w1, aed dYpKrsN wiN~ Tax AtN~ra
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