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Declaration ot Domicile and Gltizenshtp ~~s9~10
TO THE STATE AND COUNTY TAX ASSESSOR, ~
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51. LUCIE COUNTY, FLORIOA: , ~
This is my declaration of Oomicile a~d Citizenship in the State of Flo~ida that i am fiiing this dey in acoordante and
~n conformiy with Chapter 222, Section 222.17, Flo~ida Statutes.
1 was formerly a legal resident of Bnterprise Alahn~w
(Cily1 (State)
and ! ~esided at _ 108 1[emie Stre~t _ . However 1 have changed my domiti~e
(Street and Number)
to and am ar?d have been a bona fide resident of the State of Florida since 1at day of
- J~~~' , 19
68 , and 1 reside at 1706 Paaeo Avenue
(Street and Number)
PORT PiERCE, SAINT lUCIE COUNTY, RORIDA •
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and this statement is to be taken as my declaration of citizenship, actua) legal residence and domitile in the State of Ho~ida.
(Inse~t here any pertinent fads, such as sate of property or busineu, or relinquishment of employment
at former domicife, ~emoval of family to new domicile, purchase of Fwme, etc.)
PLACING CBILD IN SCHOOI,
?racie Herring - 5 peara
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~ FIlEO AND RECORDED
ST. LUCIE COUNTY. FLA.
4i'~ C~~~' `.'~~,;..`Ft, !
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S8 J!!L 31 AM I'
' .:~/l~~ ~1 ^'oi i I\YJ
C~~RK CiRCUtT COURT
1 FURTHER CERTIFY that I will comply witfi all other requirements of a legal resident of this State.
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1 FURTHER CERTIFY that 1 have no intention to return to my former domiule, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, flOR1~A, permanentty. j
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(Name) ~
Wayne L. H ring i
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1706 Paseo Ave.., Ft. pierce, Fle. _
- (Address) ~
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Sworn to and subscribed before me thia day of - , ~q
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ROGER POITRAS -
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CIRCU COU J- .~~Q~~•... 7~,"=. Notary Public `
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gY ~ ' : My ~ommission axpires
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~ Ro b~ ~x~cuhd in dupitc#ti~..~!:iA~~1~` wi16 Cl~eic Ci+a+it Cour?, and duplicN~ wHh Tax Ast~saoa) .
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