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Decla~atio~ ot Domicile and Citisenship 148Q`~'0
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. LUCIE ~OUNTY, FIORIDA: ~
~
This is my declaration of Oomicile a~d Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal ~ssident of -__Chi]~QCOte 3,.~ ~ -
~C;~y~ (State)
and 1 resided at 815 _NOith Cutright However I have changed my domic.G~e
(Sfreet and Number)
to and am and have been a bona fide resident of the State of Florida since 4tb day of
august ,~q 66 , and I res~de at 1606 Havanna Ave.
(Street end Number)
FORT PIERCE, SAIN? LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ntering child in the 2ad grade
~
~ LED AN~ ~EN~R ~
ST.RE~~Rp VERIFIEO
a,~ : 3y
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~66 ~`~r 3~ ~ 0
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! t:c i'~ U1T ~~URT.
i CLERK C~RC
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
: ~ t;_F~~T~~. CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
' e~~~ ~ rmanentl
PIER~; ;~MIT,~l~~'`{~;,COUNTY, FLORIDA, pe y.
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~ . . : ~ = Mrs. Ronald Keeer
:P~,,. :`--1 -
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; ~ ' (Address)
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Sworn to and subscribed before me this 30th day of Au~uSt ~~q 66,
ROGER POITRAS
CIRCUIT COURT Notary Public
gy ~a'~''~`'`^"~ D.C. My Commission expires
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(To b~ exscurod in dupliute snd ori~inal ~iled w~th Clerk Grcuit Court, and dupliut~ with Tax Ass~ssor.)
eooK 153 522
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