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Deciaration ot Domicile and Cltizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR. 148~5
Sl. IUCIE COUNTY, FLORI~A:
This is my declaration of Oomicile a~d Citizenship in the State of Florida thst I am filing this day in actordanoe and
in co~formity with Chapter 222, Section 222.17, Flotida Statutes.
Sodus New York
1 was formerly a tegal ~esident of -
(CitY) (State)
and 1 resided at _ SOdus POint Road, North kOSe _ __~~„~ever 1 havechanged my domicjle
(Street and Number)
b and am and have been a bona fide ~esident of the State of Florida since 8--_ day of
~ February ,~q 66 a~ ~ reside ar 110 Celestia Court
- (Street and Number)
I~ORT r1ERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Staro of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of empioyment
at former domicile, removal of family to ne~r domicile, purchase of home, etc.)
.
r Bstablishing reaide~e ~ - ~
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~ I FURTHER CERTIFY that 1 will oomply with all other requirements of a leyal resident of this State.
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1 FURTHER CERTIFY that t have no intention to retum to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~ -f R,:.'': - Prancis B, Shanahan
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Svirorn ~b ani! subsuibed before me this day of , 19 .
ROGER POITRAS
CLERK CI UIT COURT Notary Public
By D.~. My Commission expires
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(To b~ ~x~cut~d in dupliub and oripinal filed with Cl~lc Cirwit Court, and duplicat~ with Tax Ass~s:or.)
soac156 ~ 240
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