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Declarati~r~ o! Domicil~a and Citizenship ~ 1 i~
Td THE STATE AND COiJNTY 7AX ASiES.50R,
51. LUCIE COUNTY, FLORIDA
This is my declaration of Domici!e and Citizenship in the 5tate of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Jonerborv
I was formerly a legal resident oF Georgii
. ~~iry) (State)
and 1 resided at _ ~3? ~8d _ Howev~r I have changrd my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since . 8~ day of
November ~ 9F5 • ].~t01~ angle ~t?ad
- - - , , and I reside at - - - -
(Street and Number)
FORT PIERCE, SAINT tUCIE COUN7Y, FLORIDA
.;:;~i~'•~~;,:,,;.f;
end this statement is to b~ taken as my decfaration of citizenship, actual legal re~sidence and domicib ia tbe`$~fj!-(~~ida.
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(Insert here any pertinerst facts, such as sale of property or business, or relinquishment qf emplo~/mettt.~~'•:
at former domicile, removal of fam~ly to new domicile, purc~ase of home, etc.) •
a TG PLACE ~IILDREN IN 5(~OOZ .
~c~, - _ ~ ' _ ~
$aY3d~'a G• BUI'fi@ti'te 13 ~?ra+
Larrgr Lee Bnrdette 26 F I ~E~~~ j`7 ~ E C D E D
16~ ~?~~K
'65 P~OV 2 2 PM ! Z: 0 7
~ ~~~?r.~~ i''
• U
ROGtr~; r ~ . CLtt~K
ST. i_UCI~ COl1NTY,
FLORIDA
I FURTHER CERTIFY that I~vill comply with al) other requiremersts of a legai resident of this State.
I FURTWER CERTIFY that I have no intention to return to my former damiGile, and I intend to remain in FORT
PlERtE, SAINT LUCIE COUNTY, FLORIDA, permanently.
_ l~~.~'~~ 6~
(Name) Montie Holc~e
~ __~?~1a.^!~ An~la Raada_Ft. Pierce, ~l~'l~-
~
• :t`'~ . , • (Address)
.....~"'r ~
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= - Swo~r,n•to'~n~ subscribed bPfore me this --_-2~~ _ _ day of -_-~~o~~~r_ , 19
~ -
_
~ ~ : ~ ' .
' ~l ~ ~ • ~~S
. _ : - _ _
~~%;~L~~'' ~OtJIT URT Notary Public
,s~~ .
gy -'~t _ _ ~.C. My Cammissior. expires _
(To be executed in dvplicate and original fil~sd with Cierk Cirtuit CouN, and duplitats with Tax Assasto~.)
gaoK ~3~. 355
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