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Declaratio~ ot Do~nicile and Citize~ship
YO THE STATE AND COUNTY TAX ASSESSOR. 163538
Sl. LU~IE COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapte~ 222, Sectian 222.17, Florida Statutes.
I was forme~ly a legal resident of __~_4_ H; 1 ~~g~._ _ New Te~r Se X__ ~
(Ciy) (State)
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and I resided at _~___9_Gram@rCy LSne ~Wever I havechanged my dorritjle
(Street and Numbe~)
'o and am and have been a bona fide resident of the State of Florida since day of '
August ^ , ~9 6? and 1 reside ar _ 120 S. E. Banvan Drive
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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 facts, such as sale of properry or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, ett.)
Establishing residence
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F~lEO AND RECORD~p y
S+• !-UCtE CnUt~TY, FLA. ~
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CLERK ClR~u~T couRr ~
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1 FURTHER CERTIFY that I wil) comply with all othcr requirements of a(eyal resident of this State. ~
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t fURTHER CERTtFY ihat I have no inteniion to return to my forrner domic.ile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _ ~
. ~::1i:.:::7:1j~~~ • , ~
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- ' ~G`'.•• C'~~''%• (Name) _
"...~''~G`:~. William A. Finn ~
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~Sv,~~om?6 aecl~s~ibscribed before me this 16 day of J an u a r,y , ~ q~_,
ROGER POITRAS
K CIRCUIT COURT Notary Public
gY D.C. My Commission expires
(To b~ ~x~cuhd in dupliuh snd oripinst ~iled witi~ Cfklc Grcuit Court, and dupliut~ with Tax Ass~ssor.)
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