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~ Declaration at Darre~ciie a~d Citizanship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ' ~ t'~~"-~
Sl. IUCIE CC~UNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the 5trte of Floride that I arr~ filing this day in actordance a~d
in c~nformity with Chap~er 2?2, Section 222.17, Florida Statutes.
I was formerly a legal resident of . _ _ _~H~___~. _
(City) (State)
Rt 2 Box~ Tboaas Trailor Court
end ! reside~d at _ . However I have changed my domicjle
(Street and N~mber)
to and am a~d have been a bona fide resident of the State of Florida since 22th _ day of
-----~41~ 196$__, and I reside at __R.1dg~CSQS~~ ~
• (Street and umber)
WRT PIERCE, SAINt LUCIE tOUNTY, FLORtDA
and this statement is to be taken as my declaration of citi2enship, actual legal residence and domicile in the 5tate af Florida.
{Insert here any pertinent facts, such as sale of property or F~usiness, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ntering child in scho~l
FlLEp .ND ftECeRBEp
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.r :•rL rSVili,~~ r~` ~~A~,
;1~~.,.... ~:.1... t~~,,` S T. L U ~ I E~ C O U J T Y,~ ~
~ , FI.ORIDA
~
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiSile, and I intend to remain in FOR7
PiERCE, SAtNT IUCIE COUNTY, FtORiDA, permanently.
_•c~r;~. -
1 I~~•i ,
'S•;,ll~!~~ ~r^`'~r,i. JC--~~~~ . 2~--J~~~ - ~ ~Y~v
;y :'~.~~1``-~•. (Namel
,
_ :"~s~`• .a': • Mrs. Ra1 ph C Snyder
. . r~ , f : !f _
~ •r~y_ • Y
t",~'•. - .:1~ ~ (Address)
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aath ~ugust b5
Sworn to and subscribed before me this day of , 19 .
ROGER POfTRAS
K CiRCtJIT C URT Notary Public
~...~.L.~-c,i ~0o~-~c.7~
D.C. My Commission expires
(To bs ~xstuf~d in duplicats snd ariginal ~iled with Clarlc Gircuit Covrt, and duplitats with Tax Assr?sso~.)
~ BURK