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Declaration ot Domicile and Citize~ship
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TO THE STATE AND COUNTY TAX ASSESSOR,
S1. LUCIE COUNTY, FIORIDA:
This is my declaration of ~omicile and ~itizenship in the State of Florida that 1 am fili~g this day in accorda~ce and
in tonformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _,_~_~?~~~~lin A~ F.__B. Florida _ ;
(C~ty) (State) ~
and I resided at Ele~_R09d _ However 1 have changed my domic~le
(Street and Number)
to and am and have been a bona fide resident of the State of Flo~ida since ~ 960 (June ) day of
4~0 Brookwood Drive, Athens, Ga. !
_ _ _ _ , 19 , and I reside at '
(Street and Number) ,
FORT PIERCE, SAlNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in ihe State of Horida.
(Insert htre a~y 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.)
Filing to become a permanent resident of Florida...now aerving in ~
,
the armed forcee of the IISA, but intends to reside here upon
retirement from the 1[ilitery.
Owns property in S outh Port St. I,ucie '
FILEO AND RECORQED
ST, lUC1E COUNTY, FLA.
i :f=C(~Rr: ~~^RIF{~D
i 18'7fiE'i i
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~ '~9 p~C 30 PM 2 :01 ~ '
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C~ERK CiRCU1T COURT 4
1 FURTHER CERTIFY ttf~ I will comply with all other requirements of a leyal ~esident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (am lbert S. use,Jr
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~~.e.~~~ ~l1~-+~
} (ita~ic~md~c Bette G. Rrause
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" :••Swom.to'end subscribed before me this 30th day of ~eeember ,~q~~,
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~ _ ROOER..R0~1'It~?S
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~ , CLERK CIRCUlT COURT Notary Public
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~ gy . D.C. My Commission expires
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(To b~ ~xscutsd in dupliuro snd oripfnal ~iled with Cl~rk Grwit Court, and duplicst~ with Tax Ass~ssor.) ~
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~ gooK18~ PacE281~ ~
~ No. 13
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