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Declaration ot Domicile a~d Citizensh~p 1~~8~
TO 7NE STATE AND ~Ol1NTY TAX ASSESSOR,
Sl, lUC1E COUNTY, FLORIUA:
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This is my declaration of Domicile and Citizenship i~ the State of florida thst 1 am fitiny this day in aco~rdancs and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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Albanq N. Y.
1 was formerly a legal resident of
(City) (Stats)
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and 1 ~esided at 9 Aorman Ave. ~ . Hcwever 1 have char~geti my domiCile '
(Street and Number) -
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ro and am a~d have been a bona fide resident of the State of Florida since ~h day of
6 ~ Zake l~anor Park Zot 52 ~
Degember_ , 19_~, and 1 reside at ~
(Street and Number) _ . _
fORT PIERCE, SAINT LUCIE COUNTY, FIORIDA ~
and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicilein the State of Horida. ~
(lnsert here any pertinent fads, such as sale of propery or business, o~ relinquishment of employment
at former domicile, removal of family to new dorr~icile, purchase of home, etc.) :
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Hesidence _
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FILED AND RECOROED
ST. ~UC~E COUNTY. FLA.
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190896 ~
'10 ~~"r:~ 9 Ff~ !2 : Q 2 ~
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CL=R~C ~iR'~tl1T COURT `
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1 FURTHER CERTIFY that I wil) o~mply with afl other ~equiremenfs of a legal'resident of this State.
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I FURTHER CERTIFY that I have no intention to retum to my former domicjte, and t intend to remain in fORT -
PIERCE, SAINT LUCIE COt1NTY, FtORIDA, permanently. l,ry, ~ C~~~~ ~
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Mra. Dorot y Q. Fowler
(Name)
I,ske Manor Park Zot 52 ~
Star Route, Jensen Beaoh. Fl 3345?
(Address)
Swom to and'3ubst~ibed before me this 9th day of YBrCh ~ ~q~0__ ~
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QOGER POI~S~: c . -
1 ` :CbUI~; s Notary Public
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By D.C. My Commission expires
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(To be'oxetu~~d'~n ~duplicate and original frled with Cl~rlc Grwit Couil, and duplicst~ with Yax Ass~ssor.)
BOOK 1~J PAGE1~ 1 1.
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