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D~claration ot Domicil• and Citis~nship 1~ !
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TO THE STATE AND COUNTY TAX AS.SESSOR, ~
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Sl. IUCIE COUNTY, FLORI~A:
, This is my detlaration of Oomitile a~d titise~ship in the State of Flotida that 1 am filir~ this day in aooordano~ snd
in aonformlty with Chapter Z22. Settioin 222.17, Florida Ststutes.
Weverly West Virginia i
I was formsrly a ipal rosident of
(~iy) (St~») i
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and 1 rosidsd ~t . Fbwever I haw charpsd my domit3le j
(Streef and Number) ~
ro ~nd am ~nd have beer? a bo~a fide roside~t of the State of Florida sinoe Janua ry 1? ~y ~ ~
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t9~, and ~ roside a~ 4214 Garrison Lane <<
(Street and Numbe~) ~
l~ORT M~, SAINT LNCIE COUNTY, ROR~A
and this statement is ro be taken as my dacla~ation of citizenship, actual legal r~idenos and domidle in the State of Horida. f
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pnsert hero any pertinent facts, suth as ssle of property or busineu, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) '
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Tobias L. Travis
RILED AND RECOROEb ~
ST. LUCIE COUNTY. FLA. `
RE: COip~~g ~
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'69 JAN 20 AM 9' I 2 '
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' R R POt7RAS
' CIRCUfT COURT ~
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1 FURTHER CERTIFY that 1 will oomply with ali other requirem~nts of a lepal resldsnt of this State. ~
. •~•.•!;flJRTHER CERTIFY that 1 have no intention to retum to my former domi~ile, and I intend to remain in fORT
PIE$~~.S,p,c~; WCIE COUNTY, FIORIDA, permanently.
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' • - (Name) Earl Travis
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20 Jenuary 69
S,w~orn to and subsuibsd before me this dsy of 19 .
ROOER ~OITRA~
CtMK C~CIMf COtIRT Notary Public
6y ~ ` D.C. My Commission ~xpins
R~ w~oauA~ i~ a~i ~ei~l f~i wiN~ ~ CMwiM C«M, a~i ~ wYM Tavc A~ra
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„ ~175 ~li3p
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