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Declaration ot Lyomicile a~d Citizenship
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TO THE STATE ANC COUN7Y iAX ASSE~SOk ~ 3~ )`~J~
Si LUCIE COUNTY, FIORIDA
ihis is declaration of Do~n~c~te and C~r~rensh~p ~n the 5tate of Flor;da tnat I am til~ng this day in accordance and
in conformity with Chapter 222, Section 222 17, Florida Statutes
I was formerly a legal resident of Detroit '.10 Mls~l]..~',8II---- ~
~~~tY~ (State)
Florida Street ~ 5491
and I resided at _ _ However I have changed my domiCile
(Street and iJumber)
to and am and have been a bona fid~ resident of the State of Florida since 15~~ day of
~L A.$ ~ ~olOZik
Maq ~q b5 and ~ reside at Rt 2_Box'.3261 Deland Strett____ _
- - ~ . {Street and Number)
FORT PIERCE, EAiNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declarat:on of citizenship, actual lepal residence and domicile in the 5tate of Florida.
{Insert hei~ ~~y nertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new dornic~le, purchase of home, etc.)
Jan S(Doi~zik) Vuerra is establishing this as her permenaat
residency- - her husband is in the Dip].omatic service and travels
so she is claiming Ft.Pi~rce as her legal residence-~
Ft p. RE RDED
~ , - ~ ; , 'v ~OOK
~ , e ~ c?~-~1..C '
~ '65 ~I~!~;+ I 5 A.N1 l0 : 26
, _ . . ' 3C~:~?~:1
: .
, ~ ~ Ro~~h ~~J,rHas. CLERK
. , ~ ST. LUCIE COUNTY,
~j • FI.ORt~A ~
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTiFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORiDA, permanently.
Il . y _1~'~t`~
C~-' -~`t'-- ' - ~
~ ' ' (Name
. - c~ •
- Jan S u~rra
. (Address)
. . •
Swflrn to and subscribed before me this 15tb day of _______JUne ~q ~S
ROGER POITRAS - - _
K CIRCUIT . OURT Notary Public
~ l`'~ ~~t'_ D.C. My Comm;ssion expires
(To be executed in duplicate a~d original filed with Gerk Cirwit CouH, and tlupliute with T~x /AssQStor.)
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