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Declaration of Domlcll• and Citisenship
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 1 am filing this day in acoordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of
Penns Grove
(City)
(State)
and I resided at Quilley Town Road
_. However 1 have changed my domidle
(Street and Number)
b and am and have been a bona fide resident of the State of Florida since August 28 day of
i9.b.4_, and I reside at Route 3, Box 541 Campbell Road
(Street and Number)
FORT MERLE, SAINT LUCIE COUNTY, RORIDA
aril 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 fads, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Placing child in school
Garry Matthews
~14E-0 AND-.RECORDED
ST: Lt1l~IC COUNTY. Fla,
~~: n1 to \~«~''~r~
1824Q6
'69 ~I,,, 29 P~ 12:39
;i~
;, ~. ~ s
LI.ERK C;RC~UlT COURT
1 FURTHER CEitTIFY that I will comply with all other requirements of a legal resident 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.
(Name) Garry Matthews
(Address)
....:::
~. ;L5nAroi~i~:,~iubsuibed before me this 29 day of August , 19 69_
'R4Giflt PO
°~~`~ CtERIC GlI~.C~Y.OURT Notary Public
i~'~ _ l
By ~ -' - _ ~ p_~;., ~ D.C. My Commission expires
_.,
Re ise exeeutad in dupliu» and original filed with Cferlc Cirwh Court, and duplicate with Tax Aseeseor.)
~,. , 3 BooK 179 ~~E 176'
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N. J.