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Declaration ot Domicil• and Citizanship ;
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TO THE STATE AND COUNTY TAX ASSESSOR, i
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ST. IUCIE COUNTY, FLORIDA: E
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This is my declaration of Domicile and Citizenship in the State of Flo~ida that I am fili~g this dsy in aaordance and
in oonformity with Chapter 222, Section 222.17, Flo~ida Statutes.
I was forme~ly a legal resident of Auntington New York
(City) (State)
and I resided at ~ 6~eTlook Dl"14~ . However i have changed my domidle
(Street and Number)
to and am a~d have been a bona fide resident of the State of Florida since Januery 1 1 day of
, 19 ?0, and I reside at _ 105 Rose1~1'1 Ave. Ft P1e~cce ~ Fla
(Sheet a~d Number) ~
FORT PIERCL, SAlkT !!!C!~ COUl~lTl?; ~t9l~!4A '
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the State of Horida. ;
(Insert here any pertinent fads, such as sale of property or business, or relinquiahment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILED AND RE~
°Y A
ST. LUCIE C~y
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'70 ,l~~ 14 PM 1 : `~3
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~tOiiC<<. ~~01 i R:,S
- CLERK CIRCUIT COURT; -
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~ I FURTHER CfitTIFY that I will oomply with all other requiremenri of a lepal resident of this State.
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I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) Alan Ysn Yelsor {
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(Address) '
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Sworn to and subscribed before me this ~ 4 day of '7SAlieTy ~ ~9 70 ;
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~ CLERK CIRWIT COURT Notary Public (
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~ - ~ D.C. My Commission expires ~
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tTo b~ ~x~cut~d in duplicat~ and ori~insl filed with Clsrk Cirwi~ Couef, and duplicat~ whh Tax A~or.)
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