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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE 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 Bainbridge
(City)
and 1 rasided at -~ BOZ 534
(Street aril Number)
Ohio
(State)
_. However I have changed my domicGle
to and am and have been a bona fide resident of the State of Florida since du19 22 day of
19_~~, and 1 reside at 104 El Si to St
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(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.)
Placing child in public school
Jeffery Allen Baldwin
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
Sworn to and subscribed before me this 2f>
/ ~~
(Name) Donna Baldwin
(Address)
_ day of August ~ 19~_
a_ .,r
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,: ~ ~RgGOt POITRAS
CIRCUIT LOUR Notary Public
By , ' D.C. My Commission expires
Re be eiacuted in duplicate and original filed with Cleric Cirwit CouA, and duplicate with Tax A*wsaor.)
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