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Declaration ot Domi~ile and Citizenship ;
1888 ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA: '
This is my declarati~~. of Domicile and Citizenship in the State of Florida that I am filing this day -in accordance ar?d
in conformiry with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of POlIt1flC Michigan
(Ciy) (State)
and 1 ~esided at ___1'T87 _Sy1V8Yl G1621 ~Wever 1 have changed my domiCi~e '
(Street and Number) -
to and am and have been a bona fide resident of the State of Florida since - ?na day of
Januar~_~ ~9_?0 and I res~o~ ar pon Yagle Trailor Crt.
(Street and Number)
FORT PIERCF, SAINT LUCIE COUNTY, RORIi:A
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 ~
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at former domicile, removal of family to new domicile, purchase of home, etc.)
Entering child in school
Establishing residence FILEO AP~D RECORDED
Si. LUCIE CQUNTY. FLA.
~?~.CO ~i 7i•=1E~
~ 18887'S
'70 J~'! 21 P~I 2: o~_
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.;''"~f:? i U4TP.AS
CLFRK C~nCUIT COURT'
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F I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domicile, and I inte~d to remain in FORT
~ PIERGE; ;~(IJ'~T•.~UCIE COUNTY, FIORIDA, permanently.
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~ _ . . 1~~~~
~ . - : ~ (Name)
~ • - = ~iaa Bowers .
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_ ~?r,,~...r•~.:~E\,~ (Address)
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_ Sworn to and subscribed before me this 2'jth day of Januar~ , ~q 70
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~ ROGER POITRAS
E
K CIRCUIT_GOURT Notary Public
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X BY Qe~,t~ TO D.C. My Commission expires
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(To bs executed in dupliute and oriyinsl ~iied with Clerk Cinuit Coutf, and duplicat~ with Tsu Ass~sso~.)
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~ ~a. , 3 - ~ gooK 182 ~A~~ 1500 ,
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