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159283 '
Qeclaration ot Domiciie a~nd Clttsenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. lUC1E COUNTY, FtORIDA: ~
This is my decla~ation of Domicile and Cititenship in the State of Florida that I am fili~p this day in aooordanos and
in conformity with Chapter 2Z2, Section 2?2,17, Florida Stetut~.
1 was formerly a legal reside~t of ~ B°rn~,ndino (~li fprpia
(City) tStat~)
and 1 ~esided at u89 ~e8t ~ii~g 3ti~eet . However I have chanQsd my domtdla
(StrEet and Number)
to and am ar?d have been a bona fide resident of the Stats of Florida sinoe 7th day of
_ ~lle tf2~ and 1 mside at 902 Boston~ >ve.. ~
(Street and Number) ;
FORT PI~CE, SAINT lUC1E COUNTY, RORIDA '
and this statement is to be taken as my declerotion of citiunship, actual legal residence and domicile in the State of Horlda. ~
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(Insert here any pertinent facts, such as sale of propery or busineu, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) t
~'htering Samual J~ Yearby in the 3rd grade ;
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. ~l AUG 2 ~ ~3
10 ~ 48
f;o,~~ ~'.orrR~s
~LERK CIR~V~r ~~URT
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' 1 fIiRTHER {~TIFY that 1 will comply witfi al! other requtremenfs of a IeQal resident of this State.
1 FUR7HER CERTIFY that 1 have no intention to return ta my former domitile, and t intend to remain in FORT
i PIERCE, SAINT LUCIE CUUNTY, FLORIDA, permaneroly.
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; c`~ Mrs A~y ( oiolet) Yeat~y
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~'S~~j~;~~8rj~auDscribed before me this ~8~ day of ~~t , 19~.
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~ ROGB ~OITRAS
~ CIRCUR COURT Notary Public
B a'`~'~'~ D.C. My Commiuion expires
(To b~ uc~arf~d ie duplicab and ai~inal Al~d with CI~e1c Cira~it Couet, and dupticN~ with Tax At~a~or.)
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