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Declaratlon ot Domiclle and Citisenship
~5:~ 5~5
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am fili~q this day in aaoo~da~os and
in conformity with Chapter 222, Section 222.17, florids Statutea.
I was formerly a legal resident of Scotch Plains New Tersev,_..
(Ciy) (State)
and 1 ~esided at _ 1~31 GOlf Street ~ , Flowever I have chanflad my domidle
(Street and Number)
to and am~and have been a bona fide msident of the State of Florida since lst day of
Juiy ~ 66 180 Lucero Drive, Port St. Lucie
, 19 , and I reside at
(Street snd Numbef)
FORT M~CE, SAINT LUCIE COUNTY, RORIDA
a~d this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the State of Horida.
(Inse~t here any pertinent fads, such as sale of property or business, or relinquishme~t of employment
at fomner domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
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1 FURTHER G'ERTIFY that I will oomply with all other requirements of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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= N~ = Cdr Aubrey H. Russell
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.,,SvVO*r? to~atid subscribed before me this 5 day of .Jasu2try ~ 19 67
ROGER ~OITRAS
CIR R COURT Notary Public
gy D.C. My Commission expires
(To b~ ~aM~d in d~pliuN and ori~inal fil~d wlth q~ric prwif Courf, and dupli~ with Tax Ats~s~or.)
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