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Decluration ot Domicile and Citizenship
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TO TtiE STATE AND COUNTY TAX AS5ESSC7R, i~.~ i{: f.j
Sl. IUCIE COUNTY, FLORIDA:
This is my deciaratio~ of DomicilE and Citizer~ship in the State of Florida that I am filing this ~+ay in accordanca and
~n confnrmity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of wts t_ _ H~a~'~ SYi~li _-1!'lfi~~j?L~d-
(~;ty) (State)
3450 TplcdO TCiriCl~ . Nowever t have changed my domiCile
and I resided at _ . _ . _ . -
(Street and Number)
to and am and have been a bona fide resident of the 51ate of Florida since 1St day ot
April 19 65_, and I reside ar _2709_~puth __16th
(Sireet and Number)
FORT PIE'~CE, SAINT tUC1E COUldTlf, FLORIDl~1
and this statement is to be taken as my declaration of citizenship, actual legal residsnte and domicile in the State of Flarida.
;Insert here any pertinent facts, such as sale of property or business, or relinquishmeni of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
New Do~icdle
F~~~AN RECORDEO
~N___
....__--~`--~cr'~:~e~.G~ 0K
'65 J[!!, F,q~ 10' S9
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. ' ~ ROGEF? POi~~ F~a5. CLERK
- ~ w' ST. LUCIE COUNTY,
~ . - - F(.ORIDA
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I FURTHER CE(tT(FY ihat I will comply with all othsr r~quirements of a legal resident of ihis State.
I FURTHER CERTIFY that I have no intention to return to my former domi4+le, and I intend to remain in FORT
PlERCE, SAtN~;l.UCIE COUN?Y, FLORiDA, permanently.
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, ~~f _ George Mi lton_ Pincus~r
- - (Name)
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. (Address) i
Sworn to ar.d subscribeci befnre me ihis --Y~~- day of - , 19 `o~ ~
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ROGER POITRAS
~ ~ - CLEiFK C! CUlT CQURT Notary Public
~ By __i"C_1 ____!L~__ D.C. M~y Commission expires
(To be sxecuted in duplitaie and original ~iled whh Elerfa Circuit Coutt, ant! dupliute wi4h Tax Ass~aasor.)
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