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DeCiaration ot DomiCile and Citisenship `~s3~'1$ f
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA: ~
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This is my declaration of ~omicile a~d Citizenship in the State of Flo~ida that 1 am filing this day in acco~dance and ~
~n co~~fo~mity with Chapter 222, Section 222.17, Flo~ida Statutes. ~
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I was formerly a legal resident of C~lga.~pr,~- ~•st yir~111j 8 - ~
(Ciy) (Staro) ;
and 1 resided at $8*'~t~~ Y1d11~-T1"itil However I have changed my domicile ~
(Street and Number)
to and am and have been a bona fide resident of the .State of Florida since ~__~nd._ day of
~ _~B C~lh@L_ , 19~~_, and 1 reside at 1 7 5 ~ tl, Q o e
~-aSOLiti~L--.l-r~- ~'?i'~tr
(Street and Number)
FORT PIERCE, SAIN? LUCiE COUNTY, FLORIDA
and this statemcnt is to be taken as my dcclaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertine~t facts, such as sale of property o~ business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Entering
Dor38 gewman in the Yourth grade
fILEO AND RECORDED
. ST, I.UCIE COUNTY. FLA.
i~E.C~J~?t+ ~'~~IF~~D
. 163'7i8
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t .i_.. ~ ll "s`^:i
Cl.ERK C1RCUtT COURT
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I FURTHER CERTIFl( that I wil) comply with all other requirements of a legal resident of this State. ~
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCiE CC)UNTY, fLORiDA, permanentty.
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(Name)1[r$ . ChSrl@ s NewaB~i '
(Lilliaa) ~
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(Address) €
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:,,~v •:'~wbrq.~'q.~e~l~subscribed before me this 22nd day of •Ta11~,v ~q_~u8, '
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:~jei`~~` . 'L~~p.:~C i'
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ROGHt ~P~AS
-J~~ ; .C•tER1~.CIR~[fi COURT Notary Public
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BX•~ ~ D.C. My Commission expires
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Ro b~ ~xecuted in dupliute and ori~inal Rlsd with Cl~rk prcuit Court, and duplicate with Tax Assessor.)
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