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Declaration of Domicile and Citlselnship
TO THE STATE AND COUNTY TAX ASSESSOR, 18~'QU
Sl. WCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of _ChattaD008a _ Tenn.
(City) (State)
and I resided at - 1360 N ConCOrd Road __ ___. However I have changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since
18th
August ~q 69 , and I reside at 607 Holly Street
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
(Address)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert 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.)
Bntering children in school
FILED AND RECORDED
ST. LUCIE COUNTY. FLA.
~+F CO~~ ~; c:~i~,Eq
.LB~~ria~..QO
CLERK CIRCUIT C URT
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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''~~^ fb and subscribed before me this
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25th
Au gus t
day of
day of
69
19
ER PORRAS
CIRI~ COURT
My Commission expires
(To he executed in duplicab and original filed with Cleric Circuit Court, and duplicate with Tax Assessor.)
Nc+. 13
Notary Public
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