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Deciaration ot Domicile and Citizenship ~8 f
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that 1 am filing this day in acmrdante and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Ll onier Pet11I• _
(City) (State)
and I resided at _ , _ _ _ . However I have changed my domiti~e ~
(Street and Number)
to a~d am and have been a bo~a fide resident of the State of Florida since _ 2$th day of
;
__November ~q 69 , and 1 reside at 2311 N. 44th St.
(Street and Number) i
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ;
and this statement is to be taken as my declaration of citizenship, actual legal reside~ce and domicile in the State of Horida. #
(Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
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(School Childrea) ~
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Roger Lee - 12th Grade (Hutchinson) •FILE.~ .{~~t0 REQpRQEp
ST.-~tyC~iE COt}~!-TY, fL~?.
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Ronald W. - lltb Grade - 18~341
Donsld J. - lOth Grade '~9 QF~ 5~
Rita D. - 4th Grade ~
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c~rr~; e~fie~~~ eoutr~
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domiGle, and 1 intend to r main in FORT
~
PIERCE, SAINT LUCIE COUNTY, 'rIORIDA, permanently.
Donal . Kern
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, (Name) i
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- ~ : = 2311 N. 44th St . ~
r~ _ ' f~: ? _ (Address)
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` ";$iyqrR to and subscribed before me this lSt day of December , ~q 6y, •
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~ ROGER POfTRAS -
CIRCUIT CO T Notary Public ~ ~ - • •
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~ 9y ~ D.C. My Commission expires ~
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~ (To be ~xecuted in dupliuts and originsl filed with Clerk Grcuit Court, and duplicats with Tax Ass~ssor.)
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~ dODK~B~ PACE~O~li
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