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Oeclaration ot Dornicile a~d Citisen~hip i
1.59397' 1
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TO THE STATE AND COUNTY TAX ASSESSOR, '
Sl. IUCIE COUNTY, FLORI~A: ~
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This is my declsration of Oomicile and Citizenship in the State of Flo~ida that 1 am filing this day in aaordance and '
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of Auburn I4aine ~
(Ciy) (State) ;
2 Iynt~uod Ave. However I have chsnged my domiGle j
and 1 resided at _
(St~eet and Number) ~
to and am and have been a bona fide resident of the State of Florida sinoe 8~ deY ~ !
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- J~Y . 1~? and I re:ide at l~tl Seranata Court '
(Street and Number) ;
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FORT PIERCE, SAINT LUCIE COUNTY, RORIDA '
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and this slatement is to be taken as my declaration of citizenship, actual legal re:idence and domicile in the State of Florida.
(Insert here any pertinent fads, such as saie of propery or business, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.) ~
- •
• -r-r.- ~~±..-~sa,.
~htering Panella in the 6th grade
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" We~nds in the 3~d ~rade ST~ E ~ RECORpED
Rc~+e~,R ~UNTY. F~q,
„ ~~39 ~Eo
Jeffery in the lst grade ~
~6T ~?s~^ Z 4 p~i ~ ~
--~'--l '2' ~ 3
C~-ER~?`;~-" .
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K CrRCU?T CoURT ~
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1 FURTHER CERTIFY that I will oomply with all other requirements of a le~al resident of thi: State.
I FURTHER CERTIFY that I have no intention b retum to my former domiGle, and I intend to remain in FORT
PIERCE,~
`~~~~~~~fG,pU~n. FLORIDA, permanently.
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:.7j' ~ ~ (Name)
-n ~ e'• - i : `•t • ~rlene Dobson ~
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~ Swom to and subscribed before me this 21~th day of A~t 19
6?-•
ROGER POITRAS
CIRCUIT COURT Notary Public
_ gy D.C. My Commission expi~es
(To b~ ~x~evt~d in duplicat~' and ori~inal fil~d with CIKIc qra+if Court, and duplicat~ whh Tu Ass~ssor.)
eaoK~.67 Pa~E2721
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