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Deciaratio.n of Dorr~icile a~l . Citiz~nship
TO THE 51'ATE ANq COUNTY ?'AX ASSESSOR, j.~~~,~ ~
Sl. LUC1E COUNTY, FIORiDA:
This is my declaration of Domicile and Gtizenship in the 5tate o# Florida that I am filing this day in acaordante and .
in conformity with Chaptcr 222, Section ~22.17, Flcuida Statutes.
I was farmerly a legal resident of __.___B~~~~-_~.~__ Htr _
(City) ~a~~
end I resided at ---_R~D._a_- - - - - _ . However 1 have cfianged my domic.ile `
(5treet and Number) :
b and am and have bcen a bona fide resident of the State of Florida since zS~ day of
~epte~ber , 19 6S, and I reside ar ~ral A ts. 1340 Sea Dri~e
(Street and Number)
FORT l~iHtCE, SAINT LUClE tOUNTY, RORlDA
and this statement is to be taken as my declaration of citiz~nship, actual legal residente ar~rd domic+ie in the Stata of Horida.
(Insert here any pertinent fads, such as sale of propcrry or business, or relinquishm~nt of employment
at former domicile, removal of family to new dornicile, purchase of home, etc.)
To Place Cbiid in School
I.a~rence To~aldsky 12 ~rs. ~~1LE ~p~
N_ ~ lD
.(o ~OK
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I FURTHER CE~2TIFY that I will compty with ~II other requirementa of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) C~ r le o~s lds]~cp
_ t~~ 1340 Seaxay Drive. Ft. Pierct,
~ (Address)
Fla.
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Swom to and subscribed before me'~~~.1 ~ day of ~ptt~bcl ~ ~q 65 ,
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ROGER POITRAS _ ' ' ~
CLERK CIRCUIT COURT - ~ ~ . ~ - Notary Publit
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__~':_L__- , s f A.C.~~' , _ ` My ~Commission expires
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(To M~x~cuhd in dupiicah and ori~iwal ~il~ witi~ C~k C'ircwt Cowf, and ~ wi1i~ 7ax AsMS~.) ;
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