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Declaratlon ot Domicile and Citizenship 1881~'2 ;
TO THE STATE AND GOUNTY TAX ASSESSOR,
Sl. LUCIE ~OUNTY, FLORIDA:
This is my declaration of Domicile a~d Citizenship in the State of Florida that 1 am filing this day in eooordante and '
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
I was forme~ly a(egal resider~t of ~ Pineola North Caralina
tCity) (Sfate)
and I resided at p• 77 . However 1 have changed my domicjle
(Street and Number)
ro and am and have been a bona fide resident of the State of Florids since lat day of
DCCC4tiLt , 19~Q, and I ~eside at Rt. ~1~ BOx 21~ Buclid Street
(Street and Number)
FOR~ PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual tegal residence and domicile in the State of Horida. ~
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purthase of home, ett.)
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FILEO ANO RECORDED' i
ST. Lt1C1E COUNTY. FLA. ~
f~FCO~~ VERIFIED
~881~'2
'70 JAN I 2 P~1 I: 4 y
~C`~J~ R ,'Oq~TN?>S ~
~ CLERK CIRCUIT COURT~
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~ 1 FURTHER CERTIFY that I will oomply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to retu F-domiCile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COl1NTY, fLORIDA, permanently. ~ -
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, ~t. IRA l~l. VANCB
(Name)
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l Rt. ~l, Box 21, Buclid 3treet
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~ _ ~ . (Address)
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~ ' Y ~ Sworn to.~rid~sv~s`~ibed before me this 12tb day of January ~~q ?0.
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~ . Roc~a~es ; -
~ , „Cr~R_
C _~COURT Notary Public
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By D.C. My Commission expires
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(To b~ ncecut~d in dupliuh and orj~inal filsd witb qKk Grark +Couif, and dupliaat~ whh Tax Ass~ssor.)
~ BooK 1$2 PacE 55$
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