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Declaratio~ ot Domicile and Citisenship
TO TNE STATE AND COUNTY TAX ASSESSOR, • ~
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Sl, LUCIE GOUNTY, FIORIDA: ~
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This is my declaration of Domiciie and Citizenship in the State of Florida that 1 a~n filin~ this day in acoordance and :
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~n conformity with Chapter 222, Section 222.17. ~lorida Statutes. ,
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1 was formerly a legal ~esident of Yari on Ohi o
(CitY) (State) ;i
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and I resided at 598 North Greenxood . However 1 hava changed my domic,ile
(Street and Number)
to and am and have been a bona fide resident of the Sfate of Florida since - 1~r~b g , day of
, 19 70 , and I reside at _ 108 So. lbth 5trQ~t '
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FORT PIERCE, SAIN? lUC1E COUNTY, FLORIDA ;
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and this statement is to be taken as my dectaration ot citizenship, actual lega) residenoe and domicile in the State of Horida. ;
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(I~sert here any pertinent facts, such as sale of property or business, or relinquishment of employment :
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at former domiule, removal of family to new domicile, purchase of homa, etc.) .
' Placing children in school - Brenda K l~daynard and Eenest 1[synard, Jr.
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FILEO AND RECOROED~ ~
S'. LUCIE COUNTY, FLA..
~C~~!' 'y£r~lF'~D ?
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'70 hlA~R 9 AM 9: S ;
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..~'"~ir? ~~?TR.;S j
CIERK~CIRCUTT COURT !
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~ I FURTHER CERTIFY that I will comply wit~ atl other requirementt of a(eyal'reaident of thts Stete.
; _ -_I "1°T-~~~1~-fhat-l--#?ave_c~o-iatention~reiurn_~_my fotmer domicjle, and_I intend to remain in FORT
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€ PtERCE, SAINT LUCtE COUMY, FLORIDA, permanently.
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~ (Name) Ernestine ynard
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Swcrrn to and s~bscribed before me this Sth day of Nercb ~ 19 TO
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CLERfG ~(R~UtT COURT Notary Public
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B'y.: ~ - Y D.C. My Commission expires
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(To b~ oxecuted in duplicate and original ~iled with Gerk GmrN Court, snd duplicab with Tax Assossor.j
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