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D~~laration ot ~on~icil• and Citisenshlp ~s~~~ ~
TO 1HE STATE AND COUN?Y TAX ASSESS012,
Sl. LUCIE COUNTY, fIORIDA:
~
This is my declaration of ~omicile a~d Citizenship in ths ~tate of Florida that 1 am filinq thi: day in aooordsnoe ac~d
in confo~mity with Chapter 2~Z, Snction 222.17, Florida Ststutes.
1 was formerly a legal ~esident of OdlSSi Tpxas
~Ci~y~ (State)
and 1 resided at _3?14 NOrth Texas However I have changed my domicjle
(Sf~aef and Number)
to and am a~d have bean a bona fide resident of the State of Ftotida since 2Dd day of
. _
llecen~n~ber___ , 19.~L~, and 1 reside at ~~01 IIPt Av~• ~
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, RORiDA ~
and this statement is to be taken as my declarotion of citi=enship, actusl legal residence and domicile in the State of Horida. j
(Insert here any pertinent facts, such ss sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purthase of home, etc.) ~
~
~ntering Wayne K Hoffnagle in the 3rd grade
F~~p AND RECORDED'
ST.~LfUC~R CVERIFIE~~~
, ~'L~~j'~
'6T DEC 5 AM 9: D9
~ 16232s
~ :~OGE~ ~•USTR~S ~
CLERK CIRCUIT COURT =
1 FURTHER CERTIFY that I will aomply with all other requi~emenn of a IeQa) resident of this State.
I FURTHER CERTIFY that f have no intent?on to return to my former domitile, and 1 intend to remain in FORT x
PIERCE, SAINT WCIE COUNTY, FLORIDA, permanently.
.;i~~:~::;1j,,- ,
`
J~~i
1f ~~C:,1, ~ `
• ` ~ (Name)
_ i Alice ( IKrs H. E. ) Hoffnagle
_ " = ~ : S' - f
- - - . v `
- . - :A:, ~ - (Address)
:v •f'~~ ~ i • .
•.~.~tt~:.
Sworn to and subscribed befbre me this Sth day of ~ecefeber , 19_b?
ROGER PORRAS
CIRCUIT COURT Notary Public
gy a~'~~ ~~1~ D.C. My Gommission expires
(To b~ ~x~cufrd in dupllcat~ snd ori~inal fii~d witk Cl~ek Grak Cou~, s~+d dupltcat~ with Tax Ass~or.)
B~K 1fi9 PAC:123?