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~eclaration ot Domicile and Citlze~ship
TO THE STATE AND COUNTY TAX ASSESSOR, lc~$Or.~
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Sj. llK1E COUNTY, fIORIDA:
~ This is my declaration of Domitile and Citizenship in ths State of Flo~ida that 1 am fiiin~ this day in aooordancs end
in conformiy with Chapter Z22, Section 222,17, Flo~ida Statutes.
I was formerly a legal_resident of Vi~ieland _ N~w ~p„~pv
(City) - (Staie)
& - .
and 1 resided at dak Road TuCkShOt However 1 have chaiqad my domidle
(Street and Number) "
to and am and have been a bona fide ~esident of the State of Florida sincr37th day of
Dece~ber , t9- 66_, and i res;de at
treet and Number)
fORT MERCE, SAINT tUC1E COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domici~e in the Stata of Horids.
(Insen here any pertinent facts, such as sate of property or business, or relinquiahment of employment
at fomner domicile, removal of family to new domicile, purchase of home, etc.)
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~nteringr--c~ildren in school F~~p
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1 RIRTHER GERTIFY that 1 wi11 oomply witfi all other requirements of a IeQal reaident of this State.
- I-fURTHFR CERTIFY that I have no intention to retum to my former domiG~e, and 1 intend to remain in FORT
PIERCE, SAINT CUCtE COUNTY, FLORIDA, permanently. - r
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~••..$~vptn tt) and subsuibed before me this 3rd day of - Januarv ~q_~,7
.
ROGER MITRAS
t1itCUR COURT Nctary Public
BY `1`'~'~ D.C. My Commission expires
- (To b~ ~x~cuhd ln duplicsh and oeioinal fil~d with CIKit Cira~if Co~et, and dupliuh witi~ Tax As~o~.)
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