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Decla~atian of Domicil• and Citizenship 1,~,42$7 ~
TO THE STATE AND COUNTY TAX ASSESSOR. ~ ~
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizonship in the State of Flwida that 1 am filing this day in aooorda~ae and
in conformiy with Chspte~ 22Z, Sectio~ 422.17, Florida Statutes. -
1 was formerly a legal ~esident of ~~RRAY pA •
(Ciy) (State)
and 1 ~esided at 33? Thomas Rd. _ . However 1 have changed my domicjle
(St~set and Number)
to and am and have been a bona fide resident of the State of Florida sinoe 26th day of
January 69 2501 N. Federal Highway
_ , 19 , and I reside at
(Street a~d Number) ~
FORT NERCE, SAINT LUCIE tOUNTY, RORIDA ~
and this statement is to be take~ as my declaration of citizenship, actval legal residence and domidle in the State of Horida.
(Insert here any pe~tinent fads, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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EvTBRING 7NE CHIID IN PUBLIC SCHOOL gT ~~v~ E C RECOROEO-
pECnR~ yERIFYFpLA.
GORDAN N. DAVIS (16 yrs) ,sg J~~ :t'7'4~$,~,
29 P~y I :5q
~p~c ~~ZP
CLEP,K ~~RCUIT COURT ~
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1 FURTHER CERTIFY that 1 will comply with a!1 other ~equirements of a lepal resident of this State.
I FURTHER CERTlFY that I hava no intention to retum to my former domicjle, and 1 intend to remain in FORT ~
F
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~
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-`t`',i+'=r,r?,1,~..,~ JOHN G. DAVIS ~
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' ` 29th _TA.~TUARY , ~q 69 i
~.i' ' ~bed before me this da of •
. ~ SNrora ~,,~Si! ~ubsu~ Y
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q,ERK p1lRT Notsry Public ?
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By .C. My Gommission expires
1T~ b~ drpiie~ah and eei~inal fH~d wilb CMrk ~inwM C~w~, aed ehrpNeaN wilb Tax A~~~a ~
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