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Declaration ot Domicile and Citisenship ~ '
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FlOR1Ua.
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance a~d
in conformity with Chapier 222, Section 222.17, Florida Statutes. ~
1 was formerly a legal resident of ._FOrdB _ N@W .1eISCj?
(City) (State3 :
;
Horsby Ave. However I have chan ed m domiGle
and 1 resided at - - - . 9 Y
(Sireet and Number)
to and am and hbve been a bona fide resident ot the State of Florida since _17th _ day of
_ February _ , 19 69 , and 1 reside at 3809 A~?e P
i
- Eeet-a~nd~~n~e~;----
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
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.) '
Bstzblishing residence ST' C~D ~N~ REC
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
~ ' . X /~LL. CJ A.~-Ff~~ 1
~ . ~ ~ ~ ~
~ . (Name)
Fred K~ Solowinski
~ .
,
, , :
; . ~ - i (Address)
~ • •
~ . . _ ,
~ . Sworn to endsubscribed before me this Sth day of J~uarq ~ 19 70
~
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~
~ ROGER POITRAS
~ LERK CIRCUIT COURT Notary Public
;at /
~ By D.C. My Commission expires
~
~ ~
~ (To bs sxecvted in duplicate and originsl filed with Clerk Grcuit Court, and duplicate with Tax Assessor.)
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