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Deciaratlon ot ~omicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. LUCIE COUNTY, FlOR10A:
This is my ~~:'!3ras:an of Q~micile and Citizenship in the State of Flo~ida that 1 am fili~g this day in actordante a~d
~n conformity with Chapter 222. Sectio~ 242.i7, Flo~ida Statutes.
Avondalle
1 was formerly a legal resident of4~13 La _Salle R08d i___ _ rvland
(City) (State)
and I resided at prin~g_ Gp.4~a~~s ~untv Nowever 1 havechAnged my domiG~e
(Sfreet and Number)
to and am and have been a bona fis~e resident of the State of florida since _~Q~h ~ _ day of
September 66 Te ~arden Sta+p Mo Pt _
^ . 19 and I reside at
(Street and Number?
!
FORT PIERCE, SAINT LUCIE COUNTY, RORiDA
and this statement is to be taken as my declaration of citizenship, actual legal residerxe and domicile in the State of Horida. ~
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(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.) ~
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Establishing residence '
1~lovin~ into thier new home at 413 Oleander Avd.
Kiver Park, Ft.Pierce, i
FILEO AND RECORDEO
S7. LUCIF COUNTY. FLA.
P.EC^R~ ~1~R1FlEO
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'66 ~EC 6 P~ I :59 '
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CL.ERK CIRCUIT COUR7 ~
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1 FURTHER CERTiFY that I will comply with all other requirements of a legal resident of this State.
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I gURTHER CERTIFY that 1 have no intention to return to my former domiGle, and I intend to ?emain in FORT ~
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PIERCE, $A~1VT IU~IE ~~QUNjY, FLORIDA, permanently. :
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~ - Paul H, ~iar
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Sworn to and subscribed before me this 6th day of Decembez , ~q 66 .
ROGER POITRAS
CLERK CIRCU COURT Notary Public
g Q'~~'~`~ D.C. My Commission expires
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(To be executed in duplicate and originsl filed with qerlc Grcuit Cour~, and dupli~ats wiNt Tax Auessor.) ~
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