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Declaration of DOln~icile and Clttzenship
TO THE STATE ANO COUNTY TAX ASSESSOR,
S1. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filirp this day in aooordarxe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of 1V~ h++~+f s Geo ~~_
(City) (State)
and I resided at _ P O Box 33 :y 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 13th day of
_ August Iq 6q ~ and 1 reside at Route 2
(Street and Number)
C/o Nosh warner
FORT r1ERCE, SAINT LUClE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Honda.
(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.)
Bntering children in school
FILED AND RECORDED
ST'~FrC~~!? VERIFIED`A~
1.82395: 06
69 AUC 29 AM ~~
ROGLR i•t71TR~S
CLERK CIRCUIT COURT
FURTHER CERTIFY that 1 will comply with all other requirements of a legal ra:ident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~•
Ma""e)Mr. Kenneth B. Yeliy
(Address)
Swor~;~R,~nd subscribed before me this 29th day of Aug~ist , 19 69,
ERIC CIt~UI'f COURT Notary Public
c,•
- : .;
gy ~ ~- D.C. My Commission expires
,p~~1r~ in dupliuh and original filed with Cleric Circuit Court, and duNli~~th T a
-.. _~ : s` - BU~UK ~1 ~/ ~~77 PACE
No. i 3
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