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~eclaration ot Domtcii~ and Citizenship 1?~~2 ~
, 4
TO THE STATE AND ~OUNTY TAX ASSESSOR, _
S1. LUCIE GOUNTY, FLORIDA:
This is m detlaration of Oomicils and Citizenshi in the State of ~lorida that 1 am filin~ this day i~ sooordanos and ~
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i~ aonformity with Chaptet 222. Section 22~.17, Florida Statutes. ~
I wa: fo~mefiy a leqal resident of She lby Ga p Ken t ucky
(City) (Staro)
and 1 rosided at . However 1 have chsrged my domidie
(Street and Number)
to and am and have been a bona fide rosident of the Stste of florida sinae 15th day of
January 69 1408 Be11Ave.
, 19 , and 1 reside at ~
(Stroet and Numbsr)
;
I~ORT M~CE, SAINT LUCIE COUNTY, RORIOA E
and this statement is to be taken as my decla~ation of citizanship, actual legal residenoe and domicile in the Staro of Florida. ~
pnsert here any pertinent facts, :uch as sale of ~~ropery or business, or relinquiahment of employment
at former domicile, removal of family ro new domicile, purchase of home, etc.)
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Entering Bobby Jo Anderson in the lst gasde
RECOR~~~
~11.E~ AN~ N~• ~~A~ .
5~ ~~~o ~ R,~~EO 2
~~r.c i~42~ . ?
,
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I 69 ,~1~
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~LERK CIR~V~S F
i RJRTHER GERTIFY that I will aompiy with ail other roquiromentt of a lepal resident of this State. ~
~
1 FURTt~ER CERTIFY that 1 have no intention to ~eturn to my former domiCile, and I intend to remain in FORT ;
~
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PtERCE, ,~~lAlr+Wlrr,)~ tOUNTY, FLORIDA, permanently. s
~ , j,. :.,;^OG',~,; ;
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j? ; , X'~~•a-' - -
. ~i~: " (Name)
~ - 41 Martha ( ~
_ ~ : Anderson Mrs Ule ) ~
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~ • J U1dd~ess)
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Sw~orn to and wbscribsd before ms th~s 28 t h ~y of J an u a r y 19 6 9. :
,
ROOER rOITRAt
CIRCWT COIIRT Notary Public
a a-c.~~i ~o c'c~1~ D.C. My Gommission expir~s
R~ M~aaail~~ M~lieal~ a~i Mi~M~I fil~ wil~ Ci~lc CkwiN Gwt, awd d~lieaM wiN~ Tax A~~a
s~i75 ?,~1497
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