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Declaration ot Domicile anti Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORtDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am tiling this dey in accordante a~d
~n conformity with Chapter 222, Section 2~2.17, Florida Statutes.
I was forme~ly a legal resident of ___Greenb~lt M8=j118Dd
(City? (StaM)
and 1 resided at 23 H Ridge ROad , However 1 havechanged my domicjle
(Street and Number)
to and am and have bee~ a bona fide resident of-the State of Florida since _?Zst~_~_ day of
February , ~9_66 and I reside at Rt. A~2 2654 Arthuts Road
(Street and Number)
FORt PIERCE, SAlNT LUCIE COUNTY, RORIDA
and this statemerst is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of p~operty or business, or relinqvishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Thomas Bdward Davis Bntering Children In School j
Patricia Ann Dllvis
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'66 FE6 23 PM 2: y6
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ROGER 01 S. CIERK ~
ST. LUCIE COUNTY,
F~ORtDA
1 FURTHER CERTIFY that I will comply with ali other requirements of a legal resident of this State.
~ .I ~FURIFt~t CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PjEQCp~ SAtiV~ U1~fEt+~OUNTY, FLORIDA, permanently. -
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~ `f ~ ~ ' ~ ~ . ; And rew Y. D~vis
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Sworn to and subscribed before me this 23rd day of February 19 66 .
.
ROGER POITRAS ~
CLERK CIRCUIT tOURT Notary Public
BY D.C. My Cammission expires ;
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ITo b~ ~x~e~M~d in dupliut~ ~nd ori~inal fil~d with tl*ric Cirwit Courf, and dupllcaN wHh Tax Ats~por.) `
30RK 139 128 BooK ~
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