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~ Deciaration af Domlcil~ a~ Citiz~eship ~
,
~ 13`78~5 ~
~ TO THE STATE AND COUNTY TAX ASSESSOR,
~ 51. LUCIE COUNTY, FIORIDA:
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• This is my declaration of [)omicile and Citizenship in the State of Florida that I am filing this dsy in actordante a~d
in conformity with Chapter 222, Sect+on 222.17, Fbrida Ststutes. ~
T-~...
~~nt..~?1re
I was farmarly a legal resident of ~.wi~~~~_-.~!~-~.-~8---_------.__.._ - -
(State)
and I resided at _ 84~ Walnnt Stitet However 1 have changed my domiGi~e
(5treet and Number)
to and am and have bren a bona fide resident of the State af Florida since 1St day of
; Jnly , 19 6S, and I reside at 215 N 39th Strt~ - y
~ (Street ar.d Number)
` FORT MERCE, Si`.INT LUCfE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual iegal residence and domicile in the State of Florida.
; (~nsert here any pertinent facts, such as saie of property or business, or relinquishment of employment
at former domic+le, removal of family to new dr~micile, purchase of home, etcJ
Bstablishiag residencq F~~ED ANd RECAR~EA
IN_~_
~40K
fintering child in school ~
65 AUG 9~1 10: 35
~3~?$~S .
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.~,~•,f , . GER PJi i R
-~~;';y;~~ ::r~' ST. LUCIE COUNTYRK
- J~' ~~~a • •
1 ' FL.ORIDA .
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. I FURTHER CERI'IFY that I will comply with aU other requirements of a lega! resident of t~is State.
I FURI`HER CERTIFY that 1 have no intention to return to my former domi~ile, and 1 intend to remain in FORT
; P~tCE, SAINT LUCIE COUNTY, FLORIDR, permanently. , ,
,:,ettt?trr ~ ~ ~ ~ ` •
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~;~~..Lj.i_t -c ` ^t1 . ~
,if~~•sy~ Irt.'.
'~~s ~Name)
~ : ~ Mrs tc. ( $iiir ) wii~ia~s
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; • ~ i ~ K~ Ji~y.l 1• ~ -
~ r~;\ . -YA~O:~:' ~ ~
• tAddress~
i R
f r ~ - c,
- .~ti „ ~ ~ 9th Au st , ~9 6~. ~
' Sworfi ~o ~nd subscribed before me this day of _ ,
. ~
ROGER POITRAS
CIRCU T COURT Notary Public
M Commission tx ires ~
~.C. y P ~
~
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(To i~ ~at~rl~d in duplieah a~ ori~irul ~iled with Ct~elc Cireuh Covef, artd duplieat~ wili~ Tax As~ssor.) -
~ ~ a~ ~24 244 ,