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Declaration ot Domicile and Citizenship
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TO THE STATE ANd COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
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This is my declaration of Domitile and Citizenship in ihe State of Florida that 1 am filing ihis day in ac~ordance and ,
in conformity with Chapter 222, Section 222.17, ~lorida Statutes.
I was fo~m~rly a legal resident of _ ~NCSSrBR _ S. C.
~~City) - _ (Siate)
and 1 resided at _Rt S _ _ _ _ - - . Nowever I have changed my domi.;ile
(Street and Number)
15 t h da of
to and am and have been a bana fide resident of the State of Flor+da since - Y
JULY 65 IZta 370? Ridgehaven Rd.
_ _ - - - - - - _ , 19~--. , and I reside at -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNYY, ~LORIDA •
and this statement is to be taken as my oeclaration of citizenship, actual legal residence and domicile in the State of Florida.
(InserP here any pertinent facfs, such as sale of property or business, or relinquishment of employment
at former domicile, removal nf family to new dornicile, purchase of home, etc.)
ENTBRING ONE <1) CHILD IN PUBLIC SCHC~L .
s
CI IARLBS HALLMAN ( 9) ~ FI
L~E
p A N G R E C R~ 0~
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AUG 2 3 AM 11: ! 9 ~:'~r'
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ROGEr t'~J~11"ti:5~ C(~~~ _:C~ ' r~ f,
ST. LUCIE COUNTY, K . ~ .
~LORIDA :G~r r
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1 FURTHER CERTIFY that I wili comply with all other requirements of a legal resident of this Stete.
I FURTi-itK CEF2TIFY that I have no intention to return to my former domic,ile, and I intend to remain in FqRT
PiERCE, SA~NT L~~CIE COUNTY, FLORIDA, permanenil~.
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(Name)
- Bupheaia S. Hallman
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da of 11~~----- 19~..
% N~ ;.5v~qtn tp 7~i~ subscribec! before me this ~ y ~,1i$ .
~f• •~•'~M`~ai~va.
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~ ~ ~~rE+~~ POiTRAS
~~~1/1 7 4 -
CtERK GRCUIT COURT Notary Public
8y - _ D.C. My Commission exp+res ~
(Ta be ~x~cufed in dupl~c+~te and origina) filed with Cleric Circuit Court, and duplitat~ with Tax Assesso~.)
B11GK ~~V ~ ~GO`#
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