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Deciaration ot Domicile and Citizenshlp 190~2~ ~ ; f
TO THE STATE AND ~OUNTY TAa( ASSESSOR. ~
51. IUCIE COUNTY, FIORIDA:
This i: my declaration of Domicile and Citizenship in the State of Ftorida that 1 am filin9 ttiis day in aooordeno~ and
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in aonformity with Chapter 222, Section 222.17, Florida Ststutes. . ;
I wss fwme~ly a leyal resident of weat Oran~e New Jerse~ _
~~iy~ ~aro)
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snd 1 resided at M~~le StTeet Howe~rer 1 have chanqed my domkile
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ro and am and have been a bo~a fide ~esldent of the State of Florida since 31 ~Y ~ F
December ~,~9
6~, and 1 ~eside at ~15 Coeonut Ane ? River k Park
(Street and Number)
FOR? PIERCE, SAINT LUCIE COUNTY, RORIDA .
snd thit statsment is b be taken as my declaration of citizenship, actual legal residenoe and domiale in ths State of Florlda.
(Iruert here any pe~tinent ~fact:, such as sale of property or buainess, or ~elinquishms+nt of employm~nt
at former domidle, nmoval of fsmily to new domicile, purchase of home, ~tc.)
Residence FlLED ,•.r:C RECORDED
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; =i `~~'~UIT COURT . .
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3 I FURTHER CERTIFY that I will oomply with all other ~equirements of a le~al resident of this State. ;
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1 FURTNER CERTIFY that I have no intention to retum to my former danicjle, and 1 intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy. ~
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~ GEORGE H. ~iAGER
~ ~ (Name)
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~ ~ _ 415 Coconut lve., River Pk '
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S~iiOrn'';q ~~Liubscribed before me this 4th day of MaTCh 19~.
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i3 . . . ~::~s,~~. :
' RGGER'+~~AS ,
N~ ~;L~~UIT COURT ~ Notary Public
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gy , f * `~~.C. My Commiuion expires
st~ .
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Ci'o b~ sx~cut~d in dupliuh aed oripinal fii~d wjtl~ G~~Ic Grwit Couh, and dupllcat~ with Tax Ass~swra
BooK 183 ~~~E 907
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