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Declaration ot Domicile and Citizenshlp
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORI~A:
This is my declarotion of Oomicile a~d Citizenship in the State of Florida that 1 am filing this day in auorda~ce and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of BIS~ C~t~__________ _
(City) • ' (State)
a~d I resided at Rt __1 , However I have changed my domic}le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ___-17_fiJL day of
_ __December , 1965 , and I ~eside at _ 710 Orange Ave.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facis, such as sale of property o~ business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
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I RIRTHER CERTIFY that 1 wiN comply with all other requirements of a legal resident oY ~'a~'°~,~,:~:-~
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f FURTHER CERTIFY that I have no intention to return to my former domic~ile, and 1 i!i ~~~d~i't~fi fORT
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PIERCE, $AINT LUCIE COUNTY, FLORIDA, permanently. '
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Sworn to end suburibed before me this day of F b- 19-~?6
ROGER PORRAS
CIRCUIT COURT Notary Public
gy p.C. My Commission expires
lTe b~ ~x~ail~d in dupliut~ and ori~inal filed wkh Cl~rlc Grcuit Court, and duplicat~ with Tax A»~ssor.)
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BooK 139 . 100.
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