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Declaration ot Domicile and Citizenship
TO THE STATE AND C4UNTY TAX ASSESSOR, 1~'73~~3
Sl. LUCIE COUNTY, FIORIDA: "
This is my declaration of Domicile and Citizenship in the State of Flo~ida that 1 am fili~g this day in aocordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of Topeka _~Cans s
(City) (Stats)
and 1 resided at 1____ However 1 have changed my domi~.ile
(Streef and Number)
to and am and have been a bona fide resident of the State of Florida since _ lst__`_ day of
Ju~o- - .~9
66 , and 1 reside at i5~9 N~ ~ Street
- (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
ant! this statement is to be taken as my declaration of citizenship, actval legal residence and domicile in the State of Ho~ida.
(Insert he~e any pertinent fads, such as sale of property or business, or relinquishment of employment
at forme~ domicile. removal of family to new domicile, purchase of home, etc.)
;
~ntering chiltiren..in schoal
FiLEO AND RECOROES
~T~RECORD VER F EO ~
s
'66 A~J~ I PM l2:2
~ 14'7303
j ;;0„~ r i•017RAS
~ ~~ERK CIRCUIT COURT
~
1 RIRTHER CERTIFY that 1 will comply with a11 other requirements of a legal resident of ihis State.
1 FURTHER CERTIFY that I have no intention to return to my former domiCi~e, and 1 intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently_ ~
`ti,:,:,:~ • ' ~ Name)
. ~ . ~ ~ Gladys Keyer
, i - y~VG~.~ . :
. i~ ,•'i~
~ : ~ (Address)
~ • .
. •
/ ~ G~ - lat ~gt , 19 ~ .
i5wo[n~to and suburibed before me this day of
. ,~f,
ROGER POITRAS
CIRCUI O~ Notary Public
g D.C. My Commission expires
(To b~ ~xecuted in dupliut~ snd ori~insl filed with CIKIc Grcuit Cou~f, snd duplicst~ with T~x Ass~ssor.)
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