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~eclaration ot Domicile and Citisenship 148321
it3 ii~iE STiiT€ t~i~I3 ~£~-:JPtTf TrtX 0~°.~aE°.uvn,
Si. LUCIE COUNTY, FIORIDA:
This is my declsrotion of Oomicile and Citize~ship in tha State of Florida that 1 am filing this day in acaordamce and
in conformity with• Chapter 222. Section 222.17, Florida Statutes.
I wes formerly a legal resident of ~T~rA GA.
(Ciy) (State)
and I resided at .,988 StBt! St. ~Wever 1 have cfianged my domidle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since lOth day of
Sept. b6 40S N. 6th St.
, 19 , and 1 ~eside at
- (Street and Number)
FORT PIHtCE, SAINT LUCIE COUNTY, RORIDA
and this statement is :o be taken as my declaration of citizenship, actual legat reside~ce and domicile in the State of F~orida.
(lr~sert h~r~ any prstinent f~ds, suth ~s sale Qf. prooerty or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
BNTBRING ONHCHILD IN PUBLIC SCHOOL
ADA NELL INZBR (14 yrs) '
FILEO AN? F;;;,~?;,EO
ST, lUr.t~ ^OU•~i ~ ~
. . lA.
•.~4. , 'icnirl~•1
'~s SEP 12 ~ 9: 47-8321
ft~v:.ft r~ .
CLERK CIRCUIT COURT
t FURTHER CERTifY that 1 wiN comply with all other requirert~enta of a lagal resident of this Stata.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PlERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
t,~s;.~i~E~~:.~~, , (Name)
,•~G~~s cav-,,
• ~
yJ,t ~ ~;'v Mrs. Neli Nale
• ~ : r~:~~1~~G~A ? '
~ ~ ~ : • ,o,; _
. (Address)
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, i ~ /~?{`,1•J ~ _ • .
. j~~ ~•,f~NI•V j~j~~y
~ ~ 12th September 66
1~•~SyYptw' .aod subscribed before me this da of ,~q
~
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,f~~~~~cii ~~:~s~'~~`' .
r
j ROGER PO
~ CLERK IR 1 COURT Notary Public
~ ~
I
BY O.C. My Commission expires
Ro b~ ~xecufa! je dupliuh and ori~insl filed with Cl~rlt Circuit Court, and duplicat~ with Tax Ass~or.)
eo~ 154 j 3~3~
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