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Deciaration ot Domicit~ a~d Citizenship -
15?9~565 ;
TO THE STATE AND COUNTY tAX ASSESSOR, .
Sl. LUCIE COUNTY, FIORIDA: ~ ~
~
This is my deciaration of Domicile and Gitizenship in ths State of Florida that 1 am filing this day in soo~rdanoe and `
~n conformity with Chapter 222, Section 222,17, Florida Statutes. • {
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1?b 1 ine '
i wss formerly s legal rosident of I11.
(City) • (Stat~)
and I resided at 749 14th itreet - HoWe~ ~ have chsnqec! my domidle
~ (Street and Numbe~)
to and am and have been a bona fids resident of the State of Floride since lst • day of
1.ulp , 19~Z, and I r~lde at .~10 1 sblin~ ICline l~nil!
(Street and Number) _
FORT PIFRCE, SAINT LUCIE COUNTY, RORIOA .
and this statement is to be taken as my declaration of citizenship, actual iegat retidenos and damitile in the State of Horids.
(Insen here any pertinent facta, such as sale of propery or busineu, or relinquishment of employmsnt
at former domicile, removai of family to new domicile, purchase of home, etc.)
Bntering Ti~othy Adias in the 3rd grade
gILED AND RECq~~_ ~
ST, IUCiE COUNTY. fL.A~. ;
RECORD VERIFIEQ 1
.La~~7W cJ i
i
'61 AUG 29 AM 10:OZ '
. _'~%tv ;
iiOG~~~t i~O~ZRAS -
CL£RK CIRCUIT COURT ~
I FURTHER ~ERTtFY that I will aomply with all other requirements of a la~al resident of thi: State. j
1 FURTHER CERTIFY that I have no intention to return to my former domivle, and 1_ intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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. .c.~~,~ ~ (Name)
- Jean Adasa C 7lra Turiey B.
_ . ' jt\ i~~ ~ (
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• . • i ~
st ~ •j'.'' • ~ (Address)
~!I^.f ,G~,~,
~ ~ ~ 29th August 67
~Sworn to and subsuibed before me this day of , 19 .
ROGER PORRAS
CIRCUR COURT Notary Public
BY `~`'~~'G' D.C. My Commiuion expires
Re b~ ~aacut~d ie duplicN~ and oei~inal Rl~d CiKUit Cou~, ~nd duplicd~ with Tax As~or.)
~~.~7. P;~2978
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