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Oe~laration ot Domicile and Citizenship 15~~,~~
TO THE STATE ANO ~OUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citize~ship 1n the State of Florida that 1 am filin~ this day in eoo~rdanoe and
i~ oo~formiry with Chapter 222, Section 222.17, Flo~ida Statutes. ~
1 was formerly a leqal resident of OKINAWA
~C~tyj (Sta»)
CB PAC DBT OKI
~ Fleet P.O., San Francisco, Claif
and 1 rosided at ~ _ . However 1 hsve chan~sd my domidle
~ (Street and Number)
_ lSth
to and am and have been a bona fide resident of the Stats of Florida since day of
December ~ ,~q bb , and ~ ros~de at 500 Seaway Dr. •
(Street end Numbsr)
.
FORT M~CE, SAINT lUC1E COUNTY, RORIDA ,
and this statement is to be taken as my declaration of citizenship, actual legal residenos and domicile in the State of Horids.
(Inse~t i~e~y pertinent fatts, such as sale of property or business, or relinquishment of employment •
st former domicile, removal of family to ~ew domicile, purchsse of home, etc.)
BNTERING TiM~ CHILDRBN IN PUBLIC SCHOOL
GI.ORIA JEAN SAPP (1? yrs)
ANN CAROLYN SAPP C16 prs).
FILE_
_Q AND RE~~'Y fl~.~
ST. wC1E COU
RECORD VERIFI~b
1517~59
- '6t JAN 10 AN 11:21 .
f ROGER POITRAS
~ C~RK ciRCUiT couRr ~
1 FURTHER CERTIFY that 1 will oompiy with all other ~equlrements of s lessl rosident of this State. -
I FURTHER CERTIFY that 1 have ~o intention to retum t~ my former domicjie, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUMY, FIORIDA, permsnently.
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`~~~~ttu!e:u,;;; - - (Name)
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; .,:;'a.•~.':: f-r' 10#h January 67
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-SW~o~tv'1o~ subsuibed before me this day of 19
~ ~~~~~~~~N 1 .
~Cll ~:i i 1GO~,~,`` ~
C~ R Notary Public
~ .
gy D.C. My ~ommission expires
(To b~ ~x~culad in duplicat~ snd ori~inal fil~d wi1i~ q~i~ Ciraiif Cou~f, and duplia~ whh Tax AsMner.) ~
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S~K~.84 ~ 39~ t
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