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Declaration ot Domicile and Citizenship
1~356~
TO THE STATE AND COU(VTY TAX A~SESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in aaordance and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
1 was formerly a lega! ~es~denr of -__Flint _ Michi~.an
(Ciy) (State)
and 1 ~esided at _ 125 WE st GrBCe laultl ~~,,,ever 1 have changed my domicGle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ____-_-_13th day of
J anua rp ~ g¢~`, and I reside at 601 So I nd ~k~ ve~ D=+ v~.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new dumicile, purchase of home, etc.)
Bstablishing residency
ANO RECOROf~Q K : . .
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I ~~ST L~CIE pA NTY. %,~:,,'?pv•
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1 RIRTHER CHtTIFY that 1 will oomply with all other requirements of a Isyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT IUGE COUNTY, FLORIDA, permanently.
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--•;~~rn to and subsuibed before me this 15th day of ~rCh ,~q66 ,
ROC~ER ~OITRAS
CIRCUR COURT Notary Public
gy D.C. My Commission expires
(To b~ uncut~d in dupliuh and oriyinal Rl~d with C{aic Ciraril Courf, and duplicat~ with Ta~c As~or.)
# a~oK 140. 360 .
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