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Declaratio~ of Domicile and Citize~ship -~~~Q~ ~
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TO THE STATE AND GOUNTY TAX ASSESSOR, ~
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Si. LUCIE COUNTY, FIORI~A: r
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordants arx!
i~ conformity with Chapter 222, Section Z22.17, Florida Statutes.
1 was formerly a Isqal resident of Buellos ~iee ~ wrgentina -
(City) (State)
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and 1 resi~ed at 3 H . However I have changed my domiti~e
(St~eet and Number)
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to and am and have been a bona fide tesi6ent of the State of Florida since 'T~~ 1 day of
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, 19 ~ and I reside at 7~5 Delaware ~venue ~
(St~eet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, F10RIDA
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State of Hotida.
(Insert here any pe~tinent facts, such as sale of p~operty o~ busineu, or relinquishme~t of employment
at former domicile, removal of famity to new domicile, purchase of home, etc.)
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ohil~ren entering echool - Silvia Denie
FILED AND RECORDED
ST. LUCIE COUNTY. FLA.
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'68 A~6 14 P~1 !2: OS
' CLERK~CIRCUIT COURT
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1 FURTHER ~ERTIFY that I will aomply with all other requirementa of a legal'resident of this State.
. I FURTHER CERTIFY that 1 have no intention to retum to my former domiGle, and ! intend to ~emain in FORT #
PtERCE,~SAINT•LUCIE ~OUNTY, FLORIDA, permanently. ~ ~
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. '~r~~ ~ ~ (Add~~:) ?35 Delaware ~ve.
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Sworn to and subscribed before me this 14th day of - 4URL19t ,~q 68 ~
ROGER POITRAS
.~C~ERK ~lRCU1T CO T Notary Public
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gy ~ ~ ~ D.C. My Commiuion expir~s
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(To b~ ~xacvt~d in duplicat~ and ori~inal fit~d wkh q~ic prcuit CouA, and duptic~t~ with Tax Ass~s~os.)
8~i~'3 P~ ~ ~3 ~ .
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