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OeclaratiQn ot Domicile a~d Cittzenship
1ss~14 ;
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in aotordance and
in confo~mity with Chapter 222, Section 222.17. Flo~ida Statutes.
I was formerly a legal resident of ___~I~~C~~_ ____--~=SS1S~an~ -
(Ciy) (State)
1 Pepper Street Natchez, Missiasippi
and I resided at _ However 1 have changed my domiti~e
(St~eet and Numb~r)
to and am and have been a bona fide resident of the State of Florida since _-______._-~~r day of
, 19~-, and I reside at Rt ~ Bp][ 440g~19
~snuary- - - - ,
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Horida. -
(Insert here any peninent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, ~emoval of famity to new domicile, purchase of home, etc.) ~
Bntering Sharron Lynn in7th. Grade
FIlEO AND RECORDE~'
Richard Anthoney in 3rd. Grade gT'?
~~~0~~ VV~~TY, FLA;' ;
RIFtEO
Charlotte Mnette in 2nd. Grade ,66 1637'14
~a~ 22 ~ io : si
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~ :C_~. ~:Q~TK~S
CLERK CIRCUIT COURT
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4 I FURTHER CERTIFY that I will oomply with all other requirements of a lega) resident of this State. ~
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I FURTHER CERTIFY that I have no interLtiAn to return to my former domiGile, and I intend to remain in FORT ~
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _ `
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V~ - (Name) Howar & Gladys Mitchell
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~ •':~J~ ~`'~~'G:~ - -
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~ _ J?~~'~ QG's,'~ " Rt. 3 Boa 4908-19 Ft. Pierce, Fla.
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~riiro ~~~W and subscribed before me this 22nd~ day of Ta~~t . 19--SL8
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~ ROGER POITRAS
~ V~LERK CIRCUlT CO T Notary Public
~ ~ .µ,o,,s~.,d
~ By Gh~ r7 eS w~ Whets~.~.__ D.C. My Commission expires ~
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(To bs ~xecutad in duplicats and oriyinal filed with Cl~k Circuit Court, snd duplicah with Tax As~swr.) :
~ a~K 170 ~ 358
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