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- ~eclaration ot Domicile and Citlzenship
TO THE STATE AND COUNTY TAX ASSESSOR. 1446'~78
51. lUC1E COUNTY, FLORIDA: ~
This is my decla~ation of Oomicile and Citizenship in the State of'Ftorida that 1 am filing this day in ecoordants a~d
~n conformity with Chapte~ 222, Section 22Z.17, Florida Statutes.
1 was formerly a legal ~es~denr of New Brunswick _ N J _
(Ciry) (Staro)
P O BOx 468 G However I have cha m domicile , ~
and I resided at • ^9~ Y
(Street and Number) j
to and am and have been a bona fide resident of the State of Florida since day of
Apri1 ~ t9 66_, and I reside at 5628 Badger Court
(Street and Numbe~)
FORT PIEftCE, SAINT lUC1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, adual le~at reside~ce and domicile in the State of Horida. f
;
(Insert here a~y pertinent fads, such as sale of property or business, or ~elinquishment of employment ~
t
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
FI .A I~~~RDE~
Bntering child in school 1N...~ 18
~l~i0p1~
'ss APR 2 5 ~
AM 10 • 06
ReGER o446`?'g ~
ST. LUCIE COUNTYRK . r~'`
FlBRI~A ~
~
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I RJRTHER CERTIFY that I will aomply with all other requiremenri of a le~al resident of this State.
1 FURTHER CERTIFY that I have no iniention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~~'!;~j~d~to~6nd subscribed befo~e me this 25th day of ~i1 19 .
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ROGER rOITRAS -
CIRCUIT CO RT Notary Public
GL....f~.L.L ~
gy ~.C. My Commission expires
(To b~ ~ ie dupllcab and oripinal R{~d whh Cl~lc Circuit Courf, and duplicsb with Tax Ats~a~or.)
600K 143 52,8
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