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Declaration of Domicile and Citizenship ~
TO THE STATE AN~ COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FtORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section. 222.17, Florida Statutes.
I was formerly a tegal r@Sident of - 1~wr1~ ann . __T~~~ _
(City) (Stab)
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and 1 resided at _-?131 Collinsville Ave. Hcwever I have changed my domiti~e
(Street and Number)
to and am and have been a bona fide resident of the Stste of Florida since Je?n. 14 day of
_ , 19 and I reside at 809 So. Onea~ Drive
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicite in the State of Horida.
(Insert here any pertinent facts, 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 reaidency
FILED AP~O RECORDED
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~ I FURTHER CERTIFY that 1 will comply with efl other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain i~ FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name) T
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~ B. . 3c oonover
- (Address)
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Syvorrt.~o.~qn.~ubi~i+bed before me this 17 day of February ~ 19 70
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C CYi1`.-COU~;~ Notsry Public
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~ By . D.C. My Commission axpires
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~y (To b~ executed in duplicate and ori~insl ~ilsd wlth Cl~ric Grcuit Court, and dupllsab with Tax.Ass~ssor.~
iti ~~a , 3 ~oK 1~2 P,~~9 '
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