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Oecldratlo~ ot Domicll~ a~d Cittzsnshlp
TO THE STATE AND COUNTY TAX ASSESSOR, , 151922
Si . lUC1E GOUNTY, FIORIDA:
This is my dec~arstion of Domicile and Citizenship in ths Stat~ of Florida that 1 am filinq this day in aooordanos a~d
in oo~formiy with Chapter ~22, Settion 222.17, Florida Statuta.
I was formerly a legal ~esident of ~~~rleston Neat ~1x'ginia
. (City) tSta»)
and i resided at ~rcle . Howevsr I hav~ chan~ed my domWl~
(Street and Numbe~) _
ro and am and have been a bona fide resident of the Staro of Norids since 17~ day of
Jn1e , 14~_, snd 1 reside at 1012 Bescb ~onrt
(Sfrest and Numbsr)
fORT ~IERCE, SAINT lUC1E COUNTY, ELORIDA
and this statement is to bs taken as my declaration of citiz~nahip, actual Isyai r~idenos and domidle in the State of Horid~.
.qnsert here any pertinent fads, :uch es sale of property or business, or r~linquithment of employm~nt
at former domicile, romoval of family to new domicile, purchass of homs, etc.) '
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F~~o ANd RECORO~o -
ST. LUCIE ~p~
?pp~jring for hosestesd RECORO VER~~~•
- 151922
` ~T JAN ~ g
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r ~~RK C1R U T COUR~
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1 FURTHER CERTIFY that 1 will aompiy with all othsr rsquiremsnts of a le~al rosident ~f tfiis State.
1 FURTHER CERTIFY thet 1 have no intention to retum to my former domicjle, a 1 intend to remain in F6RT
PIERCE, SAINT LUCIE .COUNTY, FIORIDA, permanently.
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y~ .~i wbscribed befwe ms this 1~ day of Jaanary 19 6?
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ROGER rOtTRAS _
CIRCUR COURT Notary Public
gy ~O~ D.C. My Commiuion expires
(Te b~ ~x~a~d ie dup~c~h and eri~inal fil~d whb ClKic Cinvif Couef. and duplicaN wi11~ Tax Aa~wora
~ . e~K 164 ~ 637 `
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