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Declar~tlon o1 Domicile and Citisenship ~
TO THE STATE AND COUNTY TAX ASSES50R,
Sl. LUCiE COUNTY, FLORtOA:
1"his is my decfaration of Domicile and Citizenship in th~ State of florida that t am filing this day in attordance arxl
in conformity with Chapter 222, Sect+on ~22.17, Flo~ida Statutes. -
I was formerly a legal res+dent of _~la1t'lfirid YTriC~litli `
(C~ry) ~ ^ (Stnte) -
and I ~es~ded ar __424 Dunn Str~et Hawever I have changed my domicjle
(Street and Number) "
w
to and am and have been a bcna fide resident of the State df F(orida since _ 26 day nf
October 65 1003 PeAnsylvania
- , 19--.-, and I reside at
(Stre~t and Number)
FdRT PiERCE, SAIt+IT lUt1E COUNTY, F10RIDA
aRd this statement is to be taken as my declaration of citizenship, actual lega4 residence and domicile in the State of Flarida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emplgy'rilu~ijf ~•f~;
j'~:;~, ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ;;`F •':'~~.?t~.'~`•...;',~'-
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Moving in severa 1 weeks to 1002~ S 1tJth St, ~
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' " ~~~J~,;.',: • ~
~i ~ro~ R~~ R8~
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~ntering dau~httr in lst Grade
~s~ ~CT Z ~ AM $ : ~t5
1_39'~~~3
. R~~~R f~01; RAS. CL.ER.K_ •
ST. LUCIE Co1JNTY.
~LARIDA
I FURTHER CERTIFI( that I will campEy with all other rcquirements of a legal resident of this State.
1 FURTHER CERTlFY thaf I have no intention to return ta my former domi~ile, and I intend 4a remain in FORT
PIERCE, SAINT LUCIE COUN7Y, FLORIDA, permanently.
~ ~ ~ , ; ~,-,•,,v _ ~
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? (Name)
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i ~+lrs. Linda Panntbalcer
- •'r'~,tis~~ - (Address) .
, • _ 3..;~ .•~v
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`$~n?orn to and subscrit3ed before me this 2g day of ~tObl~ ~ ~q 65
ROGER POITItAS
CLERK CUIT CCU~t Notary Public
BY ^ - ~ D.C. My Commission expires ~
CCo br ~x~eutwd in dupliut~s if1~I Off~illll ~lIA~I WMfI CIlrIC CfrCYft CC?UI'/~ and duplieatr wit1~ T~x Asa~ssor.)
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