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Oeclar~tio~ ot Domicite a~d Citisenshlp ~
~
TO THE STATE AND COUNTY TAX ASSESSOR. .lFi'+~D~.~
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Sl. IUCIE COUNTY, FIORIDA:
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This is my declaration of Domicile a~d Citizenship in the State of Florida that I am fili~g this day in aao~dance and f
~n conformity with Chapter 222, Section 22Z.17. Florida Statutes. ~
1 was fo~merly a legal resident of BOrton _ _ _.__i. Yaea.
(C~fy) (State)
and I~es~ded ar 10 Park Yale Ave. ~Wever 1 have changtd my domiti~e
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since _-_?na- day of
Q;tpb$~_ . 19
6? , and I~eside at _~'~7 Trariqu111a Av~.
(Street a~ ~lttr::'~r3
FORT PIERCE, SAINT WCiE COUNTIf. RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
1
~stabliehing reaidence F11E0 AND ~
ST, LUCIE C UNCTY ~ED
- ^ern vFR~F~ED~A'
- •s~ o~~ 16~5
26 ~y ~o: 02
: r,• , _ ?!~~fOa-ucc~'- `
~ CL~rK CIRCUfT.C~v ~
! OURT ~
~ ~
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1 FURTHER CERTIFY that 1 will oomply with all other requirements of a leyal resident of this Stafe.
1 FURTHER CERTIFY that 1 have-no intention to retum to my former dcanitile, and I intend to remain in FORT
i
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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; _OG ; ~Name) ~
~ .~'~,-c~..~°~'„~2• Victor . 8obile
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26th y Dscember 67
,~''Swp~~:td'and subscribed befo~e me this da of . 19 -
.
1
ROGER POITRAS i
K CIRCUIT OURT Notary Public ~
~~zz~ ~
gy _ D.C. My ~ommission expires
(To b~ ~x~cuhd in dupljcat~ and oripinsl Rl~d with CIKIc Grcuit Court, and dupli~,ah with Tax Aa~ssor.)
g~~ 169 PA~~ 2099
.