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Declaration of Domicile and Citlzenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~~~~p8
Sl. IUCIE COUNTY, FLORIDA:
~his is my declaration of Domicile a~d Citizenship in the State of Flo~ida that I am filing this dav in acoordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
Ma ood New Jersey
1 was fo~merly a legal resident of ~ - - ~
~~;ry~ (State) i
214 West Springvalley Ave. .~„re„e~ 1 have chan ed m domicile
and I r~sided at 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since llth day of
Februarq , 19 68 , and I reside a~ 812 So 12tb street
(Street and Number) i
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Statc of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment af employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
8stablishing residence and entering ~hild in the 8th grade
FlLEO AND RECORO~EOA._
ST. LUC~n COUGTYFD
R'r..
164588
'68 FEB 20 AM 10:35 ~ ~
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~u::~.n t~u~z ~s
CLERK CIRCUIT COURT
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I FURTHER CERTIFY that I will comply with all other require~nents of a legal resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domiG~e, and 1 intend to remain in FORT
PIERCE, SAINT LUC~E•C~1NTY, FLORIDA, permanently.
; - : a.
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J~ ~ .~!ir~i_±s~ Btbel JObt1 C7II~
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Swo'r~5'tv'and subscribed before me this 20th day of Bebruary ~ ~q 68,
ROGER POtTRAS
LERK CIRGUIT COURT Notary Public
g ~ D.C. My Commission expires
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(To b~ ~xecutsd in dupliub and ori~inal fi{~d with Cl~rk Urcuif Court, and duplicat~ with Tax Ass~stor.)
e-=~ gooK 170 P~ 1823
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