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Decla~ation ot Domicile and Citi~sns~ip
16'7i3£3
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of __._.__~@St Cb@eter _ P@~
(Ciry) (State)
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and I resided at ___Rt _ BOZ Hcwever 1 have change: my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Flo~ida since _____l~t~____~_- day of
19
68, and I reside at _ 209 South 24tn etreet
(Street and Number) -
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
F~lEO AND RECORDED
ST. ~,UCIE COI~tJTl'. FLA.
Entering Edward in the lOth grade ~j-
" Reuben in the 8th grade 16`7i3$
'68 hUIY I S AM : y 0
" Jamie in the 2nd grade ~,~*c~~
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: L'c:rK ClRCUIT COURT
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domiCile, a~d I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORiDA, permanently.
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~ Gloria ~N~'o~linson
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~ Swom to and subscribed before me this 15th day of - Yay , 19 68
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~ R ER rO1TRA5 - - - -
~ K CIRCUIT OURT Notary Public
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~ 8 ~~t~~~ O.C. M Commis~ion ex ires
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Ro b~ ~x~cvNd jn dupiiut~ a~d oripinal Al~d with C1KIc Ckcvit CouA, ~nd dupliut~ with Tax Aa~.)
~ 1?1 ~ 2574
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