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Declaration ot Domicile and Citi=enship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
51, IUCIE COUNTY, FLORIDA:
This i: my declaration of Oomicile and Citizenship in the State of Florida that 1 am filirp this day in aooo~dants and
in conformity with Chapter 222, Section 222.17, Florida Statutes. '
1 was formerly a legal resident of Btad~on _ Ftnrid~
(City) (Staro)
and I resided at _ R F D ( SO Of towD ) Howevef I have changed my domic}le
(Street and Number)
to and am and have been a bona fide resident of the Stats of Ftorida since _ 2$th day of
November ,~q62 , a~ 1 reside at Rt 2 Box 1152 Airpott Rd Bxt.
- (Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, RORIDA
~ and this statement is to be taken as my declaration of citi2enship, actual legal residence 8nd domicile in the State of Horida.
(Insert here any pehinent fads, such as sate of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) '
Bstablishing residence
RIL EEO .OE~
B~AK o
IN ~
~ PN ~ : 38
. '66 A~ 2 s~~ ~
i44 H
I RBGER POITRAS. CI.ERK ' ~
I gT, LUC~E COUNTY.
~ FLpRIDA
~
1 RJRTHER GERTIFY that 1 wilt o~mply with all other requirements of a le~al resident of this Stafe.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SI.u1dT LUCIE COUNTY, FLORIDA, permanently.
`,;;:It~~rtr -
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~~.::,i:a~•~',L
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~ :~t • = Victor J Bernard
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~ _ Joan Be~Sl~~
~ -
c; t~~;r~~u' p i 19 6f~
':~iNom fb' and subscribed before me this 20tb day of A r 1 ~ .
ROGER rORRAS
CIRCU COURT Notary Public
c?.~.rC.t.G
B D.C. My Commiuion expires
;
(To b~ ~xaerNd in duplkah and oei~ia~l fi Owilb Cl~ek Graiit Court, and ewpliah wilh Tax A~ora
_ aooK143 414
- _ _ . _ - - _ . _ 4a:~w.