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Declaratio~ ot Domicil• a~d Citisenship 1~~~~
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. IUCIE COUNTY, FLORIDA: -
This is my decla~ation of Oomicile and Citizenship in ths State of Florida that 1 am filing this day in'aooo~danos and
in confo~mity with Chapter 222, Section 222.17, Florids Statutes.
I was fo~merly a legal resident of Shelton ~0~•
(~ity) ~ (Stafe)
and 1 ~asided at 2 Windsor Road , However I hsve cha~ped my domic~ie
(Street and Number)
to a~ am and have been a bona fide resident of the State of Florida since 28th day of
dune , t9 6$ and 1 reside a~ ~ 4531 3o Federal Hiway ( Temporary)
(Street and Number)
FORT PIERCE, SAINT LUC{E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, attual legal residenoe and domitlie in ihe State of Horida.
(Inse~t here any pertinent facts, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchsse of home, ett.)
Establishing residence
' Will enter children in school this fall
RILED AND RECORDED~
~ ST. LUCIE COUNTY. FLA. -
i~E.CORn V~~i~lf_D _
11187[.)V
~~sa ~u~ 2z Pa~ i: 09 i
I ~ ~
~t0;;z R 'OtTR~S '
CLERK CIRCUIT COURT ~
~
~
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I RJRTHER CERTIFY that I will aompiy with all other requiremerits of a leyal residsnt of this ~:ate.
1 FURTHER CERTIFY that I have no intention to retum to my fo~mer domiGle, and I intend to remain in FORT
l"-'
PiERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. '
,
~„?:utti~i ~_;~~f - `
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,V~3..T. O ,
t:, ~;o'~., - r" me)
~ 'v~'t'{' : c~''•
: 1~~ Robe t J. B nton Jr.
: • , ~
: . _ - .
-IN;: :-j;,~ s_i ~OB~
~ _ ~ Elizabeth Benton
.
~~"•'•.•,~jfi'~ toG~r~'~subsuibed before me this 22r~ day of .T~?~~ . 19~$
. ••.'rr~nt~•• .
ROGER POITRAS
CIRCUIT C RT Notary hublic
ae-~ t.~ ~ .
gy D.C. My Commiuion expires
(To b~ ~x~ael~d in duplicat~ snd ori~inal fil~d wilb CIKk Cira~il Carrf, snd dupliuh wi11~ Tax As~era
r d YR~~~j P~YC~~~~ i
s No. 13 - - - • - -
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