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Declaration ot Domicile ~nd Cltizenship
1515'7~3
TO THE STATE AND ~OUNTY TAX ASSESSOR, . -
S~. LUCIE COUNTY, FLORIDA: -
This is my declarotion of Domicile and Citizenship i~ the State of Florida that I am filing this day in aaordance and
in oonformity with Chapte? 222, Section 222.17, Florida Statutea.
1 was formerly a legal ~esident of ~vittown, Pennsylvania
Kity) (Staro)
and 1 resided at 58 I.eisure L2~n!! ~ . However 1 have changed my domicile ,
" • (St~set and Numbac~
ro and am and have been a bona fide resident of the State of Florida since 10 day of
Febru ary , 19 66 a~ ~ reside at 3~ 43 Na~l c~ r n~; vo -
(Street and Number)
FORT NERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residenoe and domicile in the State of Florida.
(Insert he~e any pe~tinent facts, such as sale of property cr business, or relinquishment of employment
_ at formar domicile, removal of family to new domicile, purchase of home, etc.) "
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Establishing residence ~~O~JO~ ~ '
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~ CLERK CIRCUtT COUFiT
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1 fURTHER CERTIFY that 1 will oomply with all other requirements of a leyal resident of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domicale, and I intend to remain in FORT
PIERCE, SAIA~#iL'~1~~~~~kJ~ITY,= FLORIDA, permanently.
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~ Stanley Everett
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Sworn to and subsaibed before me this S day of Tannar~, ~q 67
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~ ROGER ~ORRAS
CIR IT COURT Notary Public
gy D.C. ~ My Commission expires
(To bs ~oc~aw/~d In duplicat~ aed ori~inal Rl~d wifh Cl~k Ciraiif CouM, and duplicat~ with Tax As~or.1
- ~ 5~164 P~ 139 ~
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