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Declaratton ot Domicile and Cittsenship
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TO THE STATE AND CQUNTY TAX ASSESSOR,
Si. lUC1E COUNTY, FI~RIDA:
This ~s my declarotion of Oomitile and CitiZenship in th~ State ot Florida that I am filimg this day in acoordsnoe a~d
in confo~mity with Chapte~ 222, Sectio~ 222.17, Flo~ida Statutes.
Troy New York
1 was fo~merly a legal ~esident of _
(City) (Stats)
and I ~esided at _ 633 Brtu1ZN?iCk ROad _~wever I have thanged my domiCile
. (Streef and Number)
to and am and have been a bona fide resident of the State of Florida since 1 day of
110
September , 19 66 ~ and 1 reside ai 3H~ bl Sito Court, Port St. Lucie
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florlda.
(Insert here any pertinenf facts, such as sals of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bn~ering Patric Gelineau in 7th Grade
F~I~D AND RECOR~EO
ST. LUCtE COUNTY, ,
RECQRO VERIFIEO
'~6 SEP 6 p~ 3; p g
148~~'7
'r'.Gi;~r? ~'0~ i
CLERK CIRCUIT COURT
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~ 1 FURTHER CERTIFY thst I will compty with alf other requi~ements of a lega) resident of this State.
.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PlERCE, SAINT LUCl~ COUNTY, FLORIDA, permanently. ~
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~ 'r~.•, ~ ~ ...~C ~'f,~ ~ (Name)
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~r,: w June Ge lineau
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Se tea~ber
~ '$Vvorji'ta~t~lOi~ibed before me this 6 _ day of p ,~q.~_,
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r ~r~/;t:!Nlli{1t`'°'
~ rtoo~.r.om~as
~ CiERK C UIT COURT Notary Public
~
~ By D.C. My Commission expires
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~ (To i» ~xacutad in dupliuh snd oripinal filed with Clerk Cirwit Court, and duplkab wifh Tax As~stor.)
~ ao~ 154 14~
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