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~ Declaration of D?ornicile and Cltlz~nship
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' TO THE STATE AND COUNTY TAX A5SES5C)R,
S"I. LUCIE COUNTY, FLORiDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in atcordance a~d `
in conformity with Chepter 222, Section 222.17, Floride Statutes.
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I was formerly a legal resident af ~ -
(Ciry) (5tate)
and I resided at 9?Q9 _CaYtn - However I have changesd my domi~ile
(Street and Number) t
to and am and have been a bona fide resident af the Stat~ of Florida since aZDd day of
SCptt~bQl 19_~s , and I reside at _ 31~Abbett
(Street and Number)
FORT PiERCE, SAINT LUCtE CDUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residente and domicile in the State of Floride.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.)
Piacing Children io School
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Grecnrell
JohnnY Virail~ Jr. 18 yra. tN+l ,A~ E~OROEp
R~ger w~yae Gre~earell 14 yra. ~OOK
Ti~othy Ciifford Greenwrll 8 yrs. ~s~r ~
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Roads. Bileea 7 yrs. ~'~r~~~~,r
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I FURTWER CERTIFY that I will comply wifih al! other requirements of a lagal resident of this 5tate.~'~~ J.t! 1 ~
1 FURTHER CERTIFY that I have no intention to return to my former dnmi4ile, and I intend to remain in FORT
PIERCE, SA1NT. WCIE COUNTY, FLORIDA, permanently.
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. ~ ' . ~ (Name)
. _ ~ : ~ • ~ , ~ , Sal1 Green~rell
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5wom to and subscribed before me this ~ 27th day of __Septeeber ~ ~q 6~,
ROGER POlTRAS -
K CIRCUIT C4URY Notary Public
' g a`'`'~'`"~ ~ D.C. My Gommission expires
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(To b~ ~x~ar'Iwd in dvpiiwNs ar~d origina) ~ilad with Cl~rk Circvit Courf, at~d duplicsh with T~x A~s~or.)
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