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~ Declaration ot Oomicile and Citizenship
TO THf STATE AND COUNTY TAX ASSESSOR,
ST, lUC1E COUNTY, FIORIDA: !
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Thi: is my declaretion of ~omicile and Citi:anship in the Stste of Florida that 1 am filinq this day in aooord~nos and ~
i~ oonformity with Chapter 222, Section 242.17, Florida Ststutes.
1 was fo~merly • legal resident of Wa3ine sv ~ ~ e r1.~.,
(~ity) (Sta»)
Route 3 ~
and 1 resided at . However I have chan~ed my domicjle
(St~eet and Number)
~ to and ~m and have been a bona fide msident of the State of Florids sincs ~1An = 4 day of
, f
, 19~, and I reside at 3602 So. Federal Highwsy
~ (Street and Number)
I~ORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my detlaratwn of citizenship, attual legal residence and domiciis in the State of Fbrida.
,
(Insert here any perti~nt fads, such as sale of property or busineu, or relinquishment of employment
at former domicile, mmovai of family to new domicile, purchase of home, etc.)
Rene• Ttuitt (Entering child i~~?b? ic school) ~88
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~ i FURTHER ~ERTIFY thst 1 will oomply with ail other requirements of a le~al resident of this State. .
~ I FURTHER CERTIFY that I have no intention to retum to my former domicjie, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) ,rrui t t
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;~3' : . U1ddress) }
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l-.,: . , . : 1 Janusry 70 :
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,Swom fo and subsuibed before me this day of , 19 .
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- Y. ~;;..fl~bt'~ER P'bl?RAS
~ ~ ` ~ ~ ; ClE1tl~`CIRCUIT COURT Notary Public
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gy D.C. My Commission expires
(To b~ ~x~cut~d in dupliut~ and ori~inal fil~d whh Cb~lc Cirwit Cou~f, and dupliut~ witb Tuc AsMS~ota
~ooK1~~ PA~E 931 .
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