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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filirp this day in aooordanoe and
in conformity with Chapter 222, Ssdion 222.17, Florida Statutes.
I was formerly a legal resident of La place Lg
(City) (Stab)
and I resided at - 55s1 ltfel reae Ttr, However I have changed my domiGle
(Street and Number)
to and am and have been a bona fide resident of the Stab of Florida since T-8t day of
Au,J[i19t - _, t9.S2.4_, and 1 reside at 1 T ~ Te2a8 nQ art -
(Street and Number)
ifORT MERLE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence anti domicile in the Stab of Honda.
(Insert here any pertinent facts, such as sale of property or business, a relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Entering Jamea Michael l[atthew8
in 12th Grade
o~~o~ .
ST1.`VC, Ro vER ~ EO
RE SS~rjs~
6 ~ 11; y5
'69 a~G
ao~E acv ~°~R~
e`ERK ~
I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
•QJ
(Name) Earl Yatthewa
(Address)
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.'' '' ~.BnivQrh.to'aad subscribed before me this ~+t+ day of _Aiial~ret , 19~_.
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~n'•,.;~.. GRGUIT COURT Notary Public
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g~, D.C. My Commission expires
~To be executed in duplicab and original filed wish Clerk CircuM Courl, and dupiiub with Tax Aseeseora
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