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~claratio~n of Domicil~ and Citl~~nship ,
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~ TO THE STATE AND CWNTY TAX ASSESSOR, ~ '
~.3`7990 ~ ~
~ Sl. IUCIE COUNTY, FIdRIDA: ~
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This is my dalaralion of Domicile and Citizenship in the State of Flari~a that I am tiling thia dey in eaorderxe and '~:5
in conformity with Chapter 222, 5ection 222.17, Florida Shtuies.
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Pents M~?ahi~RtaA, D.C~ : "
I was formerly e legal resident of ~ ~ - - `
' (City) (State) '
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and I rasided at _ However I havechanqed my domitile ~
{Street and Number) i
to and am and have been a bona fide residb~of the State of Florida since ______.__ls day ot
: Wqil~________ , ~q_6i and I roside at 104 WeS! Ptilut ~~st• Blvd ; ~
(Street and Number) , '
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Port St. Lu~cie
{ I~ PI~CE, SAlNT tUG1E COUNTY, FIORIDA
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~ _ ' end this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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~ {Insert hera any pertinent fads, such as sa{e of properry or business, or relinquishment of employment
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at former domicile, removal of family to new domicile, purchase of hame, etc.)
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~stabiishigg residence ~ ~ ~
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; George H. Spire: ia i~ the A=aed porce~ at this tise ind Miahes
~ to establiah Florida •a his legsl rtaidence.
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I FURTHER CERTIFY that ! will comply with all other requiroments of a legal retident of thi~ 5tate.
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I FURTHER CERTIFY that I have no intention to retum to former domicjle, an I intend to remain in FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. '
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(Name) (Ot~ (A~•~.«~~?in`~IY~ ;
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George H. Spirea
(Address) .
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~ Swom to and subacribed before me this 10~h; ~y pf ' , 19.~5.•
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CLERI( CIRCUIT COURT :/~y~K~ 1~~ ~'o'"' Notary Public gtate at Large
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gy 'r ~~S~ti~; Commiuian expires 8 March 196q
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(fo b~ ~x~cuhd in dupliah ~nd origi t~rk C4nn~it Courf, ~nd duplit~ wilh Tnc Awa~or.) -
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