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Deciaration o! Domicile and Cittzenship
TO THE STATE AND ~OUNTY TAX ASSESSOR, 1333~3 ,
ST. LUCIE COUNTY, flOR1~A: ~
This is my declaration of Oomicile and Citizenship in ths Stero of Florida that 1 am fllirp this dsy in xocrdanos and
in confarmity with Chapter 222, Section 222.17, Florida Statute:.
1 was formeriy a legsl ~esident of SaCr~tme2~to ~glif ~rnia
- ~ (Ciy) ' (State)
and 1~ided at 7441 Tiara Cit rus H~t . Howaver I have chan~ed my domldle i
(Sireet and Number) ~
to and am and have been a bo~a fide ~esident of the State of Florida since 18th day of
~ • Feb. ~ 19 6~ , and I reside et 106 No 24th
' - (Street and Number) 1
I~ORT MERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actuaf legal residenoe and domidie in the State of Horids. '
(Insert here any pertinent facts, such as sale of property or business, or relinquishment.of~employment >
et former domicile, remova! of family ~to new domicile, purchase of bome, etc.)
~nterinq child in lst grade ~
1333.13 .
- ~t ~hiia ~n the ~th grade ~ll` , c,y0 ~E~OFt0E0 !
_ ;
!.B?ecand~00K s
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1965 fE8 I S AM 9: 52 ~
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~ ~ ~ ROGER POITRAS, CLERK ~
- ST, IUCIE COUNTY, fIORIDA (
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(iC •O .4v~ . . . . _
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I FUltTHER CERTlFY that I w111 oomply with all other requlremenb of a le~al resident of this State. ~
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I FURTHER CERTIFY th~t I have no intention to return to my fonne~ domic.ile, and 1 intend to remain in FORT
PIERCE, SAINT LU~IE COUNTY, FIORIDA, permanently. - ~
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- ~a~~ ~
~ - ,]eanne Dohertp ;
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~ ~ ~ ~ ~ ' ' ,y = ~
: ~ t - ' (Addross) ~
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;~'c~5wa~rpaa'nd:~bxr~bed betors me ~+ts lSth ~y of Pebruary 19 65
R03ER POITRAS ~
tiRCU1T„COURT Notary Pubtk
a~.~..t~.~C. .
0Y D.C. My Commiuion expires
(To b~ ~aaeut~d In dupticat~ and ori~i~aj, fll~d wifh Cl~ric CMcui! Cou~t, ind dupfinh wbl~ Tax A~a
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