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Declaration df Dornicii• a~d Citisenship
17'46`?'1
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and ~iti=enship in the State of Florida that 1 am filing this day in aooordance and
in conformity with Chapter 222, Sectio~ 222.17, Floride Statutes.
I was fo~merly a legal residant of Biewe~tOII ~1. Y..
(CiN) (State)
Box 299
a~d 1 resided at - However 1 have changed my domlCile
(Streat and Number)
to and am and have been a bona !~ide resident of tha State of Florida since ~~_l - day of
, 19 69, and I reside at 1619 L~nwood Av nLe
(Street and Number)
FORT'IERCE, S/11NT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legat residence and domicile in the State of Horida.
(lnse~t here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residency
FILED AND itECOROED'
ST. LUCtE COUNTY. Rl.~.
RE COft~ V~RIFIEO
• 1'746'71 !
'69 f E6 ~ AN I i: 58 ,
G:~~`~'~
I ..c
i ROGEr
~OITRAS
i CLERK CIRCUIT COURT~
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1 FURTHER CERTIFY that 1 will oomply with all other requirements of a leyal resident of thi: State.
I FURTHER CERTIFY that I have no intention to retum to my fo~mer domic~le, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~
• V
• . a rank B. unthorpe
.~'i: ''if.:'
~ , _ ~ -
V~~~` 1610 Linwood Avenue Pt.Pierce.Fla.
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. - - rs G°?ddress) !
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~ ~ to snd ~u i6ed before me this l lth day of FEBRUARY 19~. ~
~ _ "i. C i •L• . ' ~
. y~t •
ROGER ~ ~RAS ~
CIRCUR COURT Notary Publk 4
By D.C. My Commiuion expires
Re b~ ~x~cuhd in dupliuN and ori~inal fil~d wi11~ CIKk C~rit. Care~, and dupticat~ wHh Tax AfMS~.)
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