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~ecia~atio~ ot oom~c~ie and Citizenship 14,~~3
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE ~OUNTY, FIORiDA:
This is my declaratio~ of Domicile and Citizenship in the State of Florida that I am tiling this day in accordante and
in oonformiy with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal res~der~r of Buf f alo _ Ner~ York _
(City) (StaM)
and 1 resided at 225 Tw0 ROd Mari lla However t have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 13t day of
August _ ,~9 66 and I reside ar 612 Ramie Lane Rv Park
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
Bstablishing residency
. ~T' LU~ E
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RFCOR~ V R~Ee~
Bn~ering son in 8th grade ,
ss AUG IS PM
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I FURTHER CERTIFY that I will comply with all other requirements of a(ega) resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ r~'~-:;~~~:'f~ Glady Franklin
''3j~8d~~dtii'to and subscribed before me this 12th day of Au~ttst , ~q 66
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ROGER PORRAS
~RK CIRCUIT OURT Notary #~ublic
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By D.C. My Commission expires
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(To bs ~x~cuted in duplicab and original filed wi 0 R lerk U~cuit Cou~f, and dupliwts wiNt Tax Ass~ssor.)
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