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Decl~ratlon ot Domicll• and Citizenship
'fl~ TNE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCiE COUNTY, FIORiqA: l~~~n~(~ ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in acaordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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` I was farmerly a legal resident of __.____~YCROISS G~~ _
i (City) _ ($tate)
1413 La~ton St.
arid ! resided at However I have changad my domicjle
(Street and Number)
~ to and am and have been a bona fide resident of the State of Florida since Z2~a _ - day of
E
1MirCh 65 71T N„ 4th St.
. - 19---, and 1 reside at ~
: (Street and Plumber) •
~ FORT PtERCE, SAINT LUCIE COUNTY, I~LORIDA
and this atatement is ta be taken as my detlaration of citizenship, actual tegal residence and damicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at farmer domicile, removal of family to new damicile, purchase of harne, etc.)
~NTBRING THRIIB C3) ~HILDRBN IN PUBLIC SCHOULS
BARBARA GALE STBPHBNS (11 yrs~ ~^~~L~D q~~ RECORDEp
ROY STBPI~i~TS (g ~DOK
: y=s ) '65 SEP 2 l
D~rr~ srBp~naivs cb yrs) S5
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Ro~ 1 ~~).w -
p ~R POiT~ag CL~RK -
ST. LUCfE COU~yTY~
~ FLORtp~
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I FURTHER CERTIFlf that I will comply with all other re~quirements of e legal residmi~~h+a`, State.~ • v' '
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I FURTHER CERTIFY that I have no intention ta return to my farmer domi~iie, and .C"~in~t~ll.~q;,~~~l~yfief~~min'FORT
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PIERCE, SAINT LUGE COUNTY, FLORIDA, permanently. '
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„ willia~N~":
~~e~ms Staphsne
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. ;a~Wbe~'No~nd subscribed before me this 2'~th day of ~Cpt• , 1965 •
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Ct~~K IOt COURT Notary Public
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By D.C. My Commission expires - ~
; (1'm be ~x~ut~d in duplicst~ and ori~inai filid with Clerk rC.~~ rt, and du ieah with Tax /1p~taor.) ;
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