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D~claration ot Domicil~ and Citi:~nship ~,73~1
TO THE STATE AND COUNTY TAX ASSES50lt,
51. UKIE COUNTY, FLORIDA: ~
This i: my d~clantion of Domicils and Citizenship in ths State of Florida that 1 am filing this day in acoordanos ~nd
in conformity with Chapter 22~. Ssttion 2~2.17, Florida Statutes. '
1 was formsrly a Ipal r.s~dent of Alta Loma ~Californis
(Cib) (Stat~)
and 1 nald~d ~t n g~ Garnet Str@et , How~vK I hsve chan~sd my domkil~
(Street and Numb~) ~
ro and ~m a~d have besn a bona fide ros'~dent of the Staro of Florida sinoe ?th day of
January , ~q 69 a~ ~ 9I9 So. 25th. Street
(Straet and Number)
!'ORT SAINT LUCIE COIlNTY, fL~ORIDA
and this :taterrient is to be taken as my dsdaration of citi~enship, actuat le~al residenoe and domidle in the Stete of Horida.
p~t hero any pertinent fads, wch as sale of property or bu:iness, or mlinquishment of employment ~
at fonr~ domidle, removal of family to new domicile, purchase of home, etc.)
Deanne Hill 15 years of age
Leighton Hill 13 years of age
gevin Hill 11 years of age
Darin Hill 8 years of age -
Trina Hiii 6 years of age Etl~~ AND RECQROED
CIE'COUNTY. FLA.
- ~:CO.RD VERI~IED
- 1'73~631 .
'69 JAtI 8 PN 12: 26 `
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i RJRTHER GfRTiFY thaf i wlil oomply with all oth~r ~equinments of a lepai resident of this Stsh.
1 fURTHER CERTIFY that 1 have no intention ro retum to m forme? domicale, and I intend remain in fORT
PIERCEt ,,$AMIT LlIC1E COUNTY, FLORIDA, permansntly.
. , ~~~'~i~~`~ s
, ' : , D~'f~Ily~T
~ ' . ~ - (Name)
- ~ • . ' ` - 919 So . 25th. St .
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~ . ~ Pt. Pierce, Plorida
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ROO~t ~OiTRAi
Gi~K CRCtMT COIIRT Notary Publk
br ~ ~3'-'-' D.C. My Co~rxnisiion ~xpir~t
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