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DeClaration ot Domicile and Citizenship~;
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE COUNTY, FLORIDA:
This is my declar~ti;,:: af !'r.^.:ici!e and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal ~es~de~r of Dalastown _ Penn _ ~
~C~~y) (State) '
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R. F. D. # 1 . However 1 have chan ed m domiGle ;
and 1 resided at - 9 Y
(Street and Number)
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to and am and have been a bona fide resident of the State of Florida since -______7th _ day of ~
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~~1_~_ , 19~, and 1 reside at 816 SO 1'~th street j
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FORT PIERCE, SAINT LUCIE COUNTY, RORIDA t
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Horida.
(Insert here any pertine~t fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
FILER ~h'D RECORDED
L:.CIF CCU"~TY, Fl..:.
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,7 ; 6 P,~1 !j : 23
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I FURTHER CERTIFY that I will oomply with all other requirements of a iegal resident of this State. (
I FURTHER CERTIFY that 1 have no intention to return to my former domiG~e, and I intend to remain in FORT
PIERCE, SAINT. LUCtE COUNTY, FLORIDA, permenently.
• ~ (Name) .
- Eugene A Shellenberger
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~ ~ ~ • . ~ (Address)
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Sworn to and subscribed before me this 6th day of January ~q ?0
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ROGER POITRAS ±
CLERK CIRC~IT COURT Notary Public ~
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gy D.C. My Commission expires ~
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~ (To bs ~xecuted in dupliut~ and orininal ~ilsd witl~ Ckrk Circuit Cou~, and dupliut~ with Tax Ass~ssor.)
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~ ~ ~3 600K~~~ PAC[ 241
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