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D~cla~atio~ ot DOmi~il• and Citizenship 144~~
TO THE STATE ANO CWNTY TAX ASSESSOR,
Sl. LlK1E C'OUNTY. FLORIDA:
This is m~? detlaration of Ownitile and Citizenship in the State of Florida that 1 am fili~g this day in atoordanae and
in ca?formity with Chaptei 2?2. Section 222.17, Florida Statutes. -
t
1 was fiorn~ly a legal resident of CleV818Ad ~
(City) (Sfafs)
and 1 resided at 13415 Shake~c Blvd. , Apartme~lt ~~2 However I have cha~qed my domidle '
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida since the first ~y ~
SeFtember , 19~, and 1~eside at 1005 South llth Street
(Street and Numberi
FORT l~tCE, SAWT LUCIE OOUNTY. RORIDA
snd this state~r~e~t is to be taken as my ckclaration of citizenship, actual legal ~esidence and domicile in the State of Florida.
(Insert here am? pertinent fads, such as sale of property or busineu, or relinquishment of employment
at former cbmicile, removal of family to ~ew domicile, purchase of home, etc.)
to establiah legal residence
~ ~N c ~ ~~ORa
'ti'~ ~40
. ~s~29.
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~ ~ ~s~E~ Po~rRAS.
~ ST. LF~A C~~NTy~ ,
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1 FUR'TNER ~HtTIFlf tfiat I will comply with all other requirementa of a lesal resident of thk State.
t FURTFIER CERT1Flf that I have no intention to retum to my former domi~ile, and I intend to remain in FORT
PfERCE. SAINT LUCIE COUNTY, FLORIDA, permanently. -
~ -i~'K~.JL. ~ , ' ~C. ' Q1/~.
(Name) Ethel B. Robinsou
~Q.~.~- ~8• ~
(Address)
- Sworn to and wbsuibed before me this _ 28~ clsy of 1~irril ~ , _ = =rr; • ~b.• _
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CLHK C~CINT t01lRT Notary Public ~.Y ~r
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- ~ D.C. My Commiuio~ expires . 'j' = .
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