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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in ao~ordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of Cincinatti
(City)
Ohio
(Stab)
Rt 2 Goshen
and 1 resided at ~~[~~ W; 1 thf r~SirCl~ However 1 have changed my domidle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ 11th day of
Sept _ 19~.Q, and 1 reside at 3602 S_ Ped• Hig wad
(Sheet 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 Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Entering gid~t Children in school.
FILED AND RECORDED
ST. LUt;IE'CtiUNTY, FLA.
1831.28
'69 SEP 17 PM 12:55
`~,
i.7r:F%t I'OITRAS -1'
CLERK CIRCUIT COURT
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Stab.
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(a e) Rowena Paxon
lc~ruxbisifx~fast~
s
(Address) ,
:,...
'; Swocin to~itnd subscribed before me this i7.th day of September , 19~tQ.
•;_. ..
t-~
CLERK CIRCt#It COURT Notary Public
i-
,~'
ily=• •'~ D.C. My Commission expires
~.
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(To bo executed in duplicab and original filed with Cleric Cirwit Court, and duplicab with Tax Assessor.)
aooK1'79 ~~E2783
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