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D~clara4ioc~ of Domicile and Citizenship
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70 THE SiATE AND COUNTY TAX ASSrSSOR,
i~ . IIICIE COUNTY, FLORIDA
This is rny declaration oi Don~ici!e and Citizenship in the State of Florida that i arn filing this day in accordance and
~n conform~ty with Chapter 222, Section 222.17, ~lorida Statutes
t
2an6SVille ~~O
1,vas formerly a legal resident of - -
(City) (State)
1019 FYndley Av~nae ~{pwever I have chan ed m domi~ile
and I resided at , _ 9 Y
(Street and Number)
to and am and have been a b~na fide resident of the State of florida since . - day of
Nov~nber 6~ 3125 Mos~d.ng Side Blvd, Port St. Lucie
, 19_ , and I reside at - -
(5treet and Num~er)
FORT PIERCE, 5AlNT LUCIE CPJUNTY, FLORIDA
ar.d this stalement is to be taken as my detlaration of citizenship, actual legal resicience and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property er business, or relinquishment of empioyment
at former dumicile, removai of family ta new domicile, purchase of home, etc.)
~ F'IL~~,.AN~ RECQRDEQ
~ Fstablishing r~sidence ~f!`'~' __R°~~_3 0 0 K
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'65 OEC I PM ! :34
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•i3~e (
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- R~GEf; F:;~~:?~,~~. CLERK ~
. - 6T. LUCIE COUNTY,
, ~ , FL~RIDA
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I I FURTHER CERTIFY that I will comply with all other requirements cf a legal resident of this State.
I FURTHER CERTIFY that I have no inte~tion to return to my forrner dorrii~ile, ard ! intend to remain in FOR7
PIfkCE, SAINT LUC1E .~OUIdTY, FLORIDA, permanentiy.
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' : . (NamA)
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• James M. Mi~ler
, ~ (Address)
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Sworn to and subscribed before me tnis _ day of _~C!"mb82` _ 1965
ROGER POITRAS - - - - - - -
CLERiC CU1T COURT Notary Puolic
6y _~'?'L-~" D.C. My Commission expires
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(To be ~xecuted in duplicate and ariginal filed with Clsrk Circuit CouH, and dupiicate with Tsx Asses~or.}
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