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Deciaratio~ ot Dornicile and Citise~ship
TO THE STATE AND ~OUNTY TAX ASSESSOR, 'O
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am fili~g this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ______~a~_Mav Cn»r~1~p115.~-.-_ _ 11e..* ior~°v_
(Ciy) (State) - - - •
and 1 resided at _ R_; _ 2__ __P~~90 Howeve~ I have changed my domitile
(Street and Numbe~)
to and am and have been a bona fide ~esident of the State of Florida since _lOth_ dsy of
October _ 19~6 , and 1 reside at ~d~ ron S reet +
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, aduat legal residence and domicile in the State of Horida.
(Inse~t here any pertinent fatts, such as sale of property or business, or relinquishment of employment
at fo~mer domicile, removal of family to new domicile, pu~chase of home, etc.)
. ~ . ' ~
Establishing residence
~p pECOR~e .
s,~~
pRp VERIF E
LA
REC GH~~,I.~
2~ ~ 3~
'66 ~ 149540
II~ iZOvER i'QIYRGS
CLERK ~?RC~~T COURT
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
i FURTHER CERTIFY that I have no intention to return to my former domiCile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
- ~ V~,(A.!/~
_ ,~,;;:111;t: ,
: `J1'j _ ' (Name)
. . - .
_ _ . - . Arthur Bllis
~ - = ' ~
- ''r' i
. . - w/
° . - ~ " 4 _ w i f e
• ~ , • Marion L. Ellis
.
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~~to and subscribed before me this 2~tb day of ~tober , ~q~_.
. -
. ~iiiS~~t~, .
ROGER POITRAS
LERK CIRCUIT COURT Notary Public
g Q''~L D.C. My Commission expires
(To be ~x~cuhd in dupliut~ and ori~inal filed with Cl~rk Grcuit Court, snd duplicat~ with Tax Ass~ssor.) ~
gooK 157 562
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