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Declaration of Domicile and Citizenship
1824~-$
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 acwrdance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Louisvi~ le Kentucky
(City) (State)
and I resided at 4834 Brenda Drive 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 A h .day of
must 192., and I reside at 506 North 2nd Street
(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.
pnsert here any pertinent facts, such as sals of property or business, or relinquishment of employment
at formar domicile, removal of family to new domicile, purchase of home, etc.)
Entering children in school
FILED ANO RECORDED
ST. LUCI;E~C~OUNTY. FIA,
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'69 SFP 2 PM ~ : 22
Lam{
r0 =E'R i'OI RAS
CLERK CIRCUIT COURT
1 FURTHER CERTIFY that I 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 domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) William G. McNabb
(µddress)
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Notary Public
D.G. My Commission expires
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(To be executed in duplicate :nd original filed with Clerk Grwit Court, and dupliate with Tax Assessor.)
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da of September 69
subscribed before rr-e this 2nd y , 19