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Decla~ation ot Oomtclle ahd Cltisenshlp ~
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TO THE STATE AND COUNTY TAX ASSESSOR, j
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Sl. lUC1E COUNTY, FIORIDA: i
This is my declsration of Oomicile and Cititenship in the State of Fforida that 1 ~m filin~ this dsy in eooordanoe and
in conformity with Chapter 222, Section 222,17, Fb~ida StatuMs.
1 was formerly a legal residtnt of sol ~,Orea
(City) (Sts»)
and 1 ~esided at , . HowevK I hsve charqed my domicjle
(Strest and Number)
ro and am and hsve bes~ a bona fide ~e:ident of the State of Florida sinoe day of
October 65
, 19 , and 1 resids at 3302 Sun ise Blvd~
(Stra~t and Number)
FORT MERCE, SAINT LUCIE tOUNTY, fLORIDA
and this statement is to l~e taken as my decla~ation of citizenship, actusl legal re:idencs and domicile in the State of Horids.
(Insert here any pe~tinent facts, such as sale of propeny o~ bustneu, or rollnqui:hment of employment
at fo~mer domicile, removal of family to new domicile, purthase of home, ett.)
F~~O ANO 1
ST, LUClE RECOROED
Applying for residence RECORO yVMTY~ F~p,
1~ ERJFJED ;
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~~.FRK CIRCUIT COURT ~
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I RJRTHER CE~tTIFY that I will oor»ply with all other requirements of a le~al reside~t of this State.
1 FURTHER CERTlFY thet I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE_ CQUNTY, FLORIDA, permanently.
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- ~ ' ° (Name) -
~ = ; ~y = - J~anne Alvey
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I Sworn 'fb'arld' iuburibed before me this 23 t h day of F~br u a r y ~ ~ 9 6 7
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; ROGER rOITRAS
~ CIRCUR RT Notary Public
~ ~~-~t~ 1 <:045t~E~fiC~
~ B D.C. My Commission expires
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~ Ro b~ ~xaart+d in duplkah an~ original A{~d whh CMrlc Cirarit Cour~, and dupli~ata with Tax Ass~or.)
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