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Declaration ot Domicile and Citizenship ~59534 ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
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51. WCIE COUNTY, FLORI~A: ~
This is my declarotion of Oomicile and Citizenship in the Stats of Flo~ida that 1 am filirp this day i~ aooordanos end ~
~n conformity with Chapter 222, Section 222.17, Florida Staturos.
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1 was formerly a legal resident of ~~8 I$18IId NeM York ~
(City) (State) :
Nolin i
and 1 ~esided at _ ~-79 ~ st,~eet . However 1 have chanqsd my domiGls t
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(Street and Number) '
to and am and have been a bona fide resident of the State of florids since ~7~ day of
?ugust , 19 67 , and I re:ide at ~ 3 l~d etY'e~t
- (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA . ~
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and this statement is to be taken as my declaration of citi=enship, actual legal resi~ence and domicile in the State of Florids.
(Insert here any pe~tinent facts, such as sale of property or busineu, or relinquishment of employment i
at former domicile, removal of family to new domicile, purchase of home, ett.)
Sntering Debra in the llth grade ST LL D AND RECORDLp ,
M -John in the 9th grade ~~co~Pn oUR~~rE~• ~
~ David in the 5th grade ~
1~9534 ~
• ~sl AUG 28 pN Z; 49 ~
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~ CLERK CtRCU1T COURT
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1 FURTHER CERTIFY that 1 will comply with all other requirements of s le~al resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT !
PIERCE, SAINT lU~~ COUNTY, FLORIDA, permanently.
. CC~s~,~~, ~
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:r ~ ^ S : _ Catherine ~ I+~rs Edxard ) &itler
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,Sworn ~to and subscribed before me this 28~ ~ day of ~t 6? •
ROGER ~OITRAS
CIRCUIT COURT Notary Public
gy D.C. My .Commission expires
(To b~ uaevbd in dupNeat~ and o~i~nal fil~d wNb Cl~elc Graiif Cour1, aed duptiul~ whh Tax At~or.)
- B~K 1~7 `~;t 2~~8
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