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D~claratiom of Do~iciio a>`zd GitizarnsiZi~
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.
I was formerly a legal resident of . Spr nIIgL: ~ 1~-' Al ab 1°a
(C;ty) (State)
and 1 resided at P• O• Bpx 39 However 1 have changed my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since Tulj~ 25 -day of
19 69, and I reside at Route 4 Box ?04-M
(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 Horida.
(Insert here any pertinent fads, 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 children in public school
Richard Bagby, Michael Bagby, Dwain Bagbq,Randq Campbell
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1 FURTHER CERTIFY that I will comply v~iith all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
Name) Margaret Campbell
(Address)
~. . ~.~.,• .~•• 26th August 19 69.
Sworn• to arfd=iebs~ribed before me this day of
'' -,~ ' , fIOGF~F ~POI~KAS
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~• • ~` LAC ClR~i11T COURT Notary Public
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D.C. My Commission expires
(To be executed in duplicate and ori9inaf firgdRwith Clerk Ci:wit Court, and duplicate with Tax Assessor.)
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