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Declaration ot Domicile and Citizenship
1'74433
TO THE STATE AND COUNTY TAX ASSESSOR, E
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the Stata of Fiorida that 1 am filing this day in acoordanoe and
in co~formity with Chapter 222, Section 222.17, Flo~ida Statutes.
I was formerly a legal ~esident of McMinnville Tennessee
(Ciy) (Stste)
and I resided at -_~425 WeSt 1?fain Strett _ . However 1 have changed my domic.i~e
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since 28tb day of
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Sedtg~ber ,~9 6$nd I reside at 1022 Ma~low~r Road
_ (Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
. (Insert he~e any pe~tinent facts, such as sale of property or business, er relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) `
Establishing residence `
FtLEO AND RECOROED4
ST. LUCIE COUNTY. FLd.'
RECOR!? VFRIFlED
1'74433
'69 FEB 3 PN 2: 44 ~
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O~E~OiTRaS
~ CLERK CIRCUIT COURT
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I FURTHER CERTIFY that I will oomply with all other requirements of a legsl resident of this State.
I FURTHER CERTIFIf that I have no intention to return to my former domicale, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. '
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• ~ L C r. ;
, : • . . . ~ ~ , John R ~ Gu~.ter f
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.-.SSnrorn to and subs~ribed before me this 3rd day of February ~ ~q 9
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_Y, . -
ROGER POITRAS ~
CIRCUIT OURT Notary Public
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gy D.C. My ~ommission expires
(To b~ ~xecut~d in duplicate and ori~inal filed with qerk Circuit Cowf, snd dupliub with Tax Ass~or.)
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