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Declaration ot Domicile and Citize~ship 'i'~5~3 ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. LUCIE COUNTY, FLORIDA: ~
This is my deciaration of Domicile and ~itizenship in the State of Flo~ida that 1 am filing this day in aooordanoe a~d ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of ~kPpchebPe _ Florida ~
~~~ty) (State) i
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and 1 resided at ___Bt 2 ~~x ~96 . However 1 have changed my domidle ;
(Street and Numbe~) 1,
Ft . Pierce ~
to and am and have bee~ a bona fide ~esident of thq/5tate of Florids sinte 1 ct asj~ of ~
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March_ , 195~_, and I reside at Dixie Mobile Home
(Street and Number)
EORT MERCE, SAINT LUCIE COUNTY, RORIDA
and this. statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Horida.
(Inse~t here any penine~t fads, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of ho:ne, etc.)
Entering children in schvol
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1 FURTHER CERTIFY that I will oomply with all other requirementt of e le~al residant of this State. ~
I fURTHER CERTIFY that I have no intention to retum to my forme~ domicjle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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(Name) Betty MCCall
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Sworn to and subscribe~d before me this ~th day of NL? rch , 19~4.
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ROQE~-~•~l~/1.Y'
~-CI~Cfy~.G~T.: Notary Public
By - ' • D.C. My ~ommission expires
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R~~bi., iw~ ~p~t~N aed o~yinal fiNd wilb Cl~ek prarM Cou~t, and dupliesl~ wMh Tvc As~o~.)
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