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Declaratlon ot Dorniciie ~nd Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, F10RIDA:
This is my declaration of Domiciie a~d ~itizenship in the State of Florida that 1 am filing this day i~ aowrdante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Charleston MI. Va. t
I was formerly a tegal resident of
(Ciry) ' (State) ;
~
and 1 resided at StBi ROUt@ BOX ?S BtullWAit 1 I have changed my domidie
(Street and Number)
to and am a~d have been a bona fide ~esident of the State of Ftorida since 20tb _ day of
June ,~9 66a~d I reside at 344 Snallwood Ave~
(Street ~nd Number~
FORT ~IERCE, SAINT LUCIE COUNTY, ROltIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domiciie in the Stat~ of Horida.
(I~sert here a~y pertinent fads, such as sale of prope?ty or business, or relinquishment of employment
at forme~ domicile, removal of family to new doMicile, purchase of home, ett.)
~ntering Nancy Lee in the 8th grade
" Norris Jr in Sth grade FI~Ep
ST AND REC~ROQO
IUCIE COUMTy
" Carol Jean in ist grade RI~E ~ V~RIFIEp~'
1R,~Oc~[.~t,~--
!b~ 26 P~ 2 : y
14~,~~2z
t•U: f R.'..S
~LERK CIRCUfT COURT
I FURTHER CHtTIFlf that t will oompty with all other requi~ements of a leyal residerit of this Stater.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SJI~~tT,~.j~CIE COUNTY, FLORIDA, permanenily_
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~,}:~r;. -~j.;!•~'~' !'l !./~/r.e.,c....e.<.t~ ie.~
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~ i'~`::- Virginia Moore
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. . •~p•~ (~?ddress)
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Sworn to and subscribed before me this 2(~tb day of wuauit , 19~_.
i
ROGER POITRAS
' CIRCUIT COURT Notary Public
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BY D.C. My Commission expires
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Ro b~ ~x~evlad in duplicNs aed ori~inal Al~d with Clerk qra~it Courf, and duplicat~ wifh Tsx Ass~ssor.)
~oo~ 153 405 `
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