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Decl~ration ot Domicile and ~ittsenship
TO THE STATE AND COUNTY TAX ASSESSOR. I s~
1
Sl. LUCIE ~OUNTY, FIORIDA: ~
This is my declaration of Oomicile and Citizenship in ths State of Florida that 1 am filinq this day in a~o~rdanos and
in oonformity with Chapter 222, Ssction 222.17, Florida Statutes.
Green~ich Conn.
I was formerly a le~al resident of
Kiy) (Stats)
and i rosided at ~ Tremont Street . Ho„„e~e~ i have chanqed my domkiie
~ (Street and Number) ~
to and am and have been a bona fide resident of the State of Florida sinoe 21st day of
~ctober ,~9.~~, and 1 re~ide at 124 P~aceta Cc,~~
(Straet and Number)
FORT N~CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, act~ual legal re:idenos end domidle in the State of Horida. ~
(Insert hero any peninent facta, such as sale of property or business, or relinquishment of employment
et formsr domicils, removal of family to new domicile, purd~ass of home, etc.)
Bstabiishing residence
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CIERK~E~ ~OITR,~S
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~ 1 FURTHER CHtTIFY tfiat I will oomply with all other requiremsnri of a lepsl ~eside~t of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domic3le, and I intend to remain in FORT
PIERCE, SAINT LUCIE ~OUNTY, FLORIDA, permanently.
`~,,;~;iii:i::il;;;~.~• X
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:,`':;~•.r~~~+G~,<-3~- Wiliia~ John Moxley
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, Mar jo rie M. Iyoxieq
,j Q Taeause
''~4:!1`'.~ ~c~tO~M and subsuibed before me this 9th day of o , 19 67. .
cr::t.t . . ' -
ROQ~ER POITRAS
C R COURT Notary Public
D.C. My ~ommiuion expires
Ro b~ ~oac~hd in d~rplicst~ and oei~inal fil~d ~~qra~it ~nd ~ wid~ Tax Aa~sr.)
PA6E
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