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Declaration ot Domicile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, 159232
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citi=enship in the State of Flwida that 1 am filing this day in accotdante snd
~ n conformity with Chapter 22Z, Section 222.17, Florida Statutes. .
I wss fo~merly a legal resident of ~"^.~N Q• \v
(Ciry) tats)
and I resided at ~0.C\ C~ 1-~-~ ~ l.. V 17 However 1 have chanqsd my domitile
(Street and Number)
~
ro and am and have been a bona fide resident of the Stste of Florida since ~ ~ 0 ~ day of
S - and I restde at S84 ~N ER CO u R 1 ~
, 19 ,
(Straet and Number)
.
FORT PIERCE, SAINT IUCIE COUNTY, RORIDA ~
and this statement is to be taken es my declaration of citizenship, actual lega) residenoe and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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ST.~LV^OPC V~~1F1cpLA.
159232
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~RK CiRCUIT COURT ~
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I RJRTHER CEftTIFY that 1 will oomply with all other requirements of a Ispa) resident of fhis State.
I fURTHER CERTIFY that 1 have no intention to retum to my former domiGle, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE C~UNTY, FLORIDA, permanently.
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Sworn to and subsuibed before me this ~ day of
_ • p• ~72
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ROGER 'OITRAS ' . ' , ~
CLERK CIRCUIT COURT Notary Publk"%,
11„jjir • ~'~loeii~ ~t 4~N ,
gy D.C. My Commiuion expires ;
.
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(To b~ ~x~cuhd in d~plicata and orl~inal fil~d whh Cl~eic Gra~if CouK, and duplicab with Tax A~s~or.) ;
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