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De~laration ot aomicil~ and Citizenship ~
t0 THE STATE AN~ COJNTY TAX ASSESSOR. 163230
Sl. lUC1E COUNTY, FlOR1~A:
~
This is my declaration of Oomicile and Citize~ship in the State of Florida thst 1 am fi{ir~ this day in aooordanoe a~xl
~n conformiy with Chapter 222, Section 222.17, florida Statutes.
1 was formerly a legal resident of NOr f Olk Q'
(Ciy) (Staro)
a;~d 1 resided at _4601 IrlByf 101ver DriVe . Howevef { have thsnyed my domicjle
(Street and Numbe~)
to and am and have been a bona fide ~eside+nt of the State of Florids since lSt day of
_ ~ctober , 19_~?, and I reside at 1404 Nale CoLrt _
(Sheet snd Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residerr.e and domitile in the Staro of Florida.
(Insert here any peninent fads, such as sale of p~operty or business, or relinquishment of employment y
at former domicile, removal of family to ne~v domicile, purchsse of home, etc.)
Establishing residence
F~~E~ AN~ RECORO t
ST, IU~~E ~p~ ED
RECORD V~R?F~Ep~A.~
'68 ~qN 3 ~ j6• O
~3J~Q
f: p V ` 7 ~oo~c~~
~~ERK CIRCUIT COURt
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1 FURTHER CERTIFY that I will aomply with all other requirements of a leyal resident of this State.
i'le and I intend to remain in FORT ~
I FURTHER CERTIfY that I have no intention to retum to my for c,~ , •
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently. ~
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. Ra aond F~N hodes ;
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: • (Address) .
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Swoin'tn~and~subscribed before me this 3rd day of .l~usiy ~ ~q 68.
ROGER rORRAS
CIRCUIT COURT Notary Public
gy a~~G D.C. My Commission expires
(To b~ uunrhd in dvplieab snd ori~inal Rl~d wi11~ Cl~ek CirwH Carr1, snd duplieah with Tax Ats~s~or.)
- g~K Zb9 P~~~ 2f 74 ;