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D~claration ot t'ami~il~ and Citizenship
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` YO THE STA~C AND COUNTY TAX ASSESSOR, ~-'~~~~`3
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~ Sl. lUC1E COUNTY, ~~oa~oA: '
~ this is my declaration of Domicite and Citizenship in the State of FIq~ ida that I am filing this dsy in saordance and
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t in conformity with Chapter 222, Section 222.17, Florida Statvtes. /
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' I was formerly a legal resident of ___V~~~---- T_nn~s~ec
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, and I resided at R~V RYril _ Fbwevef I have changed my cbmiCile
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' ro and am and have b~en a bona fide ~esident of the State of ~lorida since ..._______6_~_-_______ day of '
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19~~5 and I reside at iZ3~~ nel~?'sz~.Ve•
~ {Street and Number}
FOR? r1ERCE, SAINT WGIE COUNTY, FLORIDA
end this atatement is to be taken as my declaration of citizenship, actual fegal residence and domicile in the State of Ftorida.
(Insart here any pertinent facts, such as sale af property ar business, or relinquishment of employment
at former domicile, removal of family to rsew domicile, purchase of home, etc.)
Entering Childrtn in School
~fIL ECO~O~D
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' ' ' ' iR9~ER ~'u11 i.,S CLEftK :
= ' ~ S1 ;L:UCIE COUNTY.
? T• .~I.ORIDA
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1 FURTHER CE~tTIFY that I will comply with all other requirements of a legal resident nf this State.
I FU~THER CERTIFY th~t I have no intention to return to my former domiSile, and I intend ta remain in FORT
PIERCE, SAIN7 tUCIE COUNTY, FLORIDA, permanently.
" . Orxh I,ee Mjrers
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Sworn to and sulsscribed before me this -_~~~ay of ~ . 19 v•
P.OGER POlTRAS
CLE~K CNC IT COURt Notary Public
' E g ~ - D.C. My Commission expires '
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~ (To b~ ~x~cutsd in dupliut~ and o~iginal ~iled with CIKk C~~cait Court, and duplics~ wit6 T.x A~.)
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