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Deciaration of Domicile and Citi~enship
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TU THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
Tnis is rriy ~ecl3ration of ~omicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conf~rmity with ~hapter 222, Section 222.~7, Florida Statutes.
I was formerly a legal resident of A"1exSIId~1$ _.Y$._.-.--
(City) (State)
~14 B MASOTI ~tl~Ct However I have changed my domiGile
and I resided at - - -
(5treet an~' Number)
to and am and have been a E~ona fide reside~t cf the StaTe nf Florida since 28t~1 . _ dsy of
MarCh 65 and I reside at $305 _So I~d.Rive~' Drive _
- , ~ 9-- - -
(Street and Number}
FORT PIERCE, 5AlNT LUCIE COUNTY, F10RIDA
and this statement is to be taken as my dedaration of citizenship, actual legal residence and domicile in the Stats of ~lorida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of empl~yment
aT former domicile, removal of family te new domicile, purchase of home, etcJ
- . = Est~.blishin~ residency
~ .
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. . ~ ~~~~~~Ot~ ~O~D
. - BOOK
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- 's~ ~u~ Zy a~ i~: as
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ROGEri PO( i R~tS. CLERi4 ~
Sr. LUCIE CouNTY.
~LORtDA
! FURTHEl2 CERTIFY that 1 will comply vvith all Ather requirements of a legal resident of this Stafe.
I FURTHER CERTIFY that i hav~ no inte~tion to return to my former ~omi~ile, and I intend to remain in FORT
PIERC~, SAINT LUCIE COUNTY, FLORIDA, permar~en!ly.
• " " , ~
` ' _ Roy C Bragg )
~ ~ . > -
• ~Address) ~
' • • Mary raL~B
Sworn ta and subscribed before me this -_~4f$_.____ _ day of ____~.l1IIC-.-.-_--.--- 14--b-1~-~
ROGER POITRAS -
RK ~iRCUtT Ct)URT Notary Public
D.C. My Commission expires
(To b~ executed in duplicate snd oEigina) filed wifh Clerk Circuit Court, and duplicate with Yax Assessar.)
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