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D~ciaratian ot Da?n~icile ar~d Citiz~nshfp p
TO THE STATE AND COUNTY TAX A5SESSC)R, j~~t
Sl. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida thet I am filin~ this day in eccord~ncet and
in conformity with Chapter 22Z, Section 222.17, Florida 5tatutes. '
Y
I was formeriy a legal resident of __._.~~t~_ ROSA _ Ctl~f ~
(City} ;~tate)
arcd I resided at _ z13 Su~ervi llt _~d~ . Howcve~ I have changed my domicile
(Street and Number)
ro and am an~ have been a bona fide resident of the State of Florida since 9tb_.. day of '
__~_S~`pte~ber 19 bS , and I reside at -~~_B~isibet2l AVl.
(Street ana Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual Izgsl residence and domicile in the State of Flaride.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domiule, removal of family to new domicile, purchase of home, etc.)
Entesing one child in Scbool
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! Fii~~1F~ R~BO°oK
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;t; '65 SEP 13 AN 9: 16
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. .,'c~;•''s'~`~'';;'~~~,;•.~' ROG~R PUITRAS, CLERK •
^ • ,~4 -
~ ~ ' ST. LUCI~ COUNTY.
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: ~'y = Y ~ FLQRIDA
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1 FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former do~niCile, and I intend to remain in FORT
PlERCk, SAINT LUCIE COUNTY, FLORIDA, permanently_
. ~ : ; , ___Robert L. Allen
' ` ~ , + (Name)
~ ' - ` ' 1, ~ 6 . .
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S~to~n to ard subscribed before me this ~ 13th _ d~y of _ September 19 bs
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RCC3ER POITRAS -
CLERK CIRCUt COURT Natary Public
f ~
gy ~''~1~-- D.f. My Commiss~on expires -
(To br ~x~rcuNd in duplicate ~nd original ~i ~ erk Grcu~~~t, and duplicatr witF~ Tax As*esto~.).
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