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DeClaration ot Domi~cile and Citizenship
D
TO THE STATE AND COiJNTl' 7AX ASSESSOR,
Sl. LUCIE COUNTY, FLURIDA:
This is my declaration of vomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Flarida Statutes.
I was formerly a legal resident of JACZ:SONVII.LS FLA.
(City) (Statc)
and I resided at _ 630 SCEIbtoOk Rd. However i have changed my domi~ile
(Street and Number?
to and am and have been a bona fide resident of the State ot Florida since 3th . day of
June b5 Rt. 2, Box 2771-A
- . _ . _ 19--- . , and I reside at _
(Street and Number)
PORT PIER~E, SAIN? LUClE COUNTY, FIORIDA
and this s'atement is to be taken as my declaration of citizenship, actvat iegal residence and dorriicile in the State of Florida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of en7p) py'
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at former .iomicile, remova! of family to new domicile, purchase of home, etc.) y~.•~_ ; ~
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ENTHRING THRB13 t 33 ~:iILDRBIv IN PUBLIC SCHOOLS ~ ~
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LLJCY I~. KAUL C 16 qrs) ?!+y R~ C~ROE~
GEORGB W. KAUL t15 yrs) '
DAVID J. KAUL (8 yrs) ~S5 ~ODK
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I FURTHER C~RTIFY that I will com~,~y with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that 1 have no intent:an to return to my former domi~ile, and I ir~tend to rerr,ain in FC~RT
PIERCE, SAINT IUCIE COUNTY, FLORICA, p2rmanenYly.
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• ~t~qotR.l~u and subsuibed bef~re me th's _23Td day of __AU~'USt , 19 6~.
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~ ROGER POItRA5 - f
CtERK I T GOURT fvotary Publit !
.
By _ D.C. My Commission expires ;
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(to bs exesvted in duplicate and origin:l filed with Clark Circuit Court, and dupliurte with Tax Assessor.) !
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