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Declaration of Dor~nicite aa>;d Citizeins~ip
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sj. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of
Louisville
(City)
YentucTt~
(State)
2804 Alice Awe
and I resided at 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 Yl th day of
1113 So Ocean Drive
Au ust
g , 19 69 , and I reside at Tetnp~
(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 facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Byrne
Bnteringt- Michael P s~li~ls in 8th grade
Blizabeth in the 1st grade
Tara in the 4th grade
Inlay Lynn in the 9th grade
Christine in the 11th grade
Diane in the 12th grade
FILED AND RECORDED
ST. IUCIE COUNTY. FLA.
c~ CORn VER'F;ED
ig2346
'69 ,~llC 28 QM 9 : 3
~~ ~~
~:L1^[n 1TRAS
CLERK CIR UIT COURT
1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
1 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.
~' ~ -: ~ .. '~~~~ chard Bd. ~ Byrn .
__
_.` _-,~.~_ ;t` ~ G : (Address)
. °2', 7 mot' `:
• ~. i ~ .~
~''~j.«„~'oth'td and subscribed before me this 28th day of Augut;t 19 69
. ' ~'ttr~:.,•;~ Fem.
;~~~-
ROGER POi7r2AS
K CIRCUIT UR~T ~¢
B ~`G~'C_._ D.C.
Y
Notary Public
My Commission expires
(To be oxecutod in duplicate snd or,ninal filod with Clerk Cirwit Court, and duplicate wccith~~lax Assciss~:.)
BOUII ~'~9 tY16f 1~ilV
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