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~laration of Domieile a~d Citlsenship ~
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TO THE STATE AND COUNTY TAX A55E5SOR,
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51. LUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am tilinq this day in accordance a~ s.
in conformity with Chapter 22~, Section 222.17, Florida 5tatutes.
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Ri.vtrside Conn ~ `
I was forme~ly a legal resident of _ _ - - -
(Gry) (State)
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and 1 resided at _~Q VClQ~t D~~V~____~~___ . However J have changed my domiLile ~ `
(Street and Number) . ~
to and am and hbve been a.bona fide resident of the State af Florida since ~95~___ dey of
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Au ust 65 P O Stuart F1~ ~
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(5treet and Number) -r !
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FORT PiERCE, SAINT LUCIE COUNTY, PLORlDA ~
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and this statement is so be taken as my declaration of citizenship, actual legal residence and dorr?icile in tfie State of Florida. ,
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{Insert ha~e any pertinent facts, such as sale of praperty or business, or relinquishment nf employment
at farmer domicile, removal of family to new domicile, purchase of home, etcJ
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FILED AND RECORt~~~ = ~ ~
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~ FtOGER P017RAS. CL.EltK ~ , ,
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• ~ S7. LUCIE COUNTY. !
- - FLORIDA `
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I FURTHER CERTIFY that I wili comply with all other rrquiremen"rs of a leqal resident of this 5tat~. ;
I FURTHER CERTIFY that I have no intention to return to my fo•rr~er domic,ile, and I intend io remain in FOR7
PIEt~CE;~~Ai~i~~;LUGE COUNTY, FLORIDA, ~ermanently. ~ g
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'r ~ ~ ~ ~ Juli~ Parker F1ood
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Sworn to and sulastribed before me ihis - Z~n day qf SCptelYbl~I , 19~~..
ROGER POITRAS _ - - - - - ~
CLEItK ClRCUIT COURT Notary Public
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g _~~s+2~ r~ D.C. My Commissinn expir~s t~
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(To bs ~x~cvhfd ir~ duplicats and nriginal ~ifed witi~ Clerk Ci~cuit Court, and dupliato with Tax Ass~ssor.) j
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