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DeCl~ratio~ ot Dort~i~ile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR. 159266 r
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Sl. LUCIE COUNTY, FLORIDA: t
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This is my declarotion of Oomicile and Gitizenship in th4 State of Florida thst 1 am filing this day in aoco~danoe and ;
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forr~erly a legal resident of -~Clid ~io
(City) . (Stste) ~
and 1 tesided at 12~ 279thStreet . However 1 hsve changed my domic,ile
(Street and Number)
to and am and have been a bona fide resident of the Stats of Flotida since lst day of
_ _ July , 19~, and I reside at 1926 RoyJll Palm Drive
(Street and Number)
FOltT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual (egal ~esidence and domicile in the State of Horida. ~
(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.)
gntering child in school
FILEO ANO RfCORDEO i
~ ST, LUCIE COUNTY. F~q, t
HE~OR~ VF~t~F1ED ~
- 'st Au~ t e P~ ~~9~ss ~
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:!1' ~i~~~G~~
CLERK •CIRCUIT COURT
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I FURTHER CERTIFY that 1 will camply with all cther requirements of a leyal resident of this State.
I fURTHER CERTIFY that 1 have no intention to return to my former domiG~e, and 1 intend to remain in FORT :
PIERCE, S,qIItLT:~,~IE COUNTY, FLORIDA, permaneMly.
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= . : ~ • Rpsalind Ga ~gher ( Mrs. ~ederick)
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Swo~n to end subscribed before me this i8th day of ~gu~ , 19~.
ROGER POITRAS
CIRCUIT COURT Notary Public
gy ~~-~G O.C. My .^.ommission expires '
(To b~ ~x~cuf~d in duplicaN snd ori~inal fi{~d with ClKlc Uavit Couv1, and duplicat~ with Tax Ast~ssor.)
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