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Declaration ot Domicile and Citizenship
TO THE STATE AND CGUNTY iAX ASSE~SOR,
Si IUCIE COUNTY, FLORIDA i tgt;~~~~(~
This is niy deciaration of Dor7,~c~le and Cit~zensh~p in ihe State of Florida That I arn filing this day in accordance and
~n conformity with Chapt~r 222, Sect~on 222.17, Florida Statutes
I w~~s forrneriy a leyal resident of UT110II GT`OVt ~18b~1T1a
(City) (State)
and I resided at ~2 Ut1i~t1 Gt'ove However I have changed my domi~ile
(Street and N~mber)
to and am and have been a bona fide resident of ihe State of florida since 6~ _ day of
I3ecember i9_ b5 , and I reside ar 361 Barracloth .S7-
, - - -
(S!reet and Numbsr)
FORT PIERCE, SAIN7 tUCiE COIDNTV, FLORIDA
and this statement is ro be taken as my declaration of citizensh;p, aUu~l legal residence and domicile in the 5tate of Florida.
(Inseri here any pertinent facis, such as sale of property or business, or relinquishment of employment
at ~ormer domicile, removal of `amily to new domicile, purchase of home, etc.)
Enterl.ag Oae Child in Sd~ol
. Flj,~~ ~~~C~ ~?ECORD~C
un~Ct6 IC~Ct;ti! 0 0 K
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' V J r n 1 I'~ ~ • ~1 ~
` `t.~ tl~~
F(~~:~._ . . _ , ~~._~;K
. ~'i. !_uC;' C7U~! i Y,
rLOf~IDA
I FU~iF,+~R'CERTIFY that 1 wil! ~omply with all other requirements of a legal resid~nt of this State.
" ' ,
_ - .
` y I Fl9RTHER CERTIFY that I have no intention to retum to n~ry form~r domi~iie, and I intend to remain in ~ORT
PiERCE, SAINT LUCIE COUNTY, FLORIJA, permanently.
Ruby- Srnit~
' (Name)
~ n "
. ~ ' s- j _ .
~ .1..~. (~_._i. C . . '-.~l, ~ r+-t f i c- "
.
/
(Address)
, Sworn ta and subscribed hefore me this 6~h. day of T~~~~bel' 19 ~
ROG~R POiTRAS - - -
CLERlC CIRCUIT COURT Notary Public
Y--_- p.C. N',y Camrnission expires
g ~T~-.-r%f?_ - ~'~~~-~z"''~
(To be executed in duplicate and original filed wi4h Clerk Circuit Court, snd dupliwte arith Tsx As$essor.)
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