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Declaration ot Domiclle a~d Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my d~.ia~ ot~on of Domit+la and Citizenship in ths State of Florida that I am filing this dav in eocordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
t was formerly a legal ~esident of _ _ Me~lphlB Ind .
(Ciy) (State)
and I resided at However 1 have changed my domicjle
(Street a~d Number)
to and am a~d have been a bona fide resident of the State of Florida since 28th day of
AuRUSt ,~9 ~9 and 1 ~eside at 2014 So 35th $treet
(Street and Number) .
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration af citizenship, actual legal residence and domicile 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 ~ew domicile, purchase of home, ett.)
Eatablishing residence
' FI[.ED-ANO REC~FtD~~
ST. LUCIE C~UNTY. F'li~;,
R~CORD VERlFIED
19137'2
'TO MAR 23 PN 3: 20
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! RO~ER PO!TRAS
~ CLERK CiRCUIT COU.R~
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~ I RIRTHER CEltTIFY ihat I will oomply with all other requirements of a Isyal resident of this State. ?
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I FURTHER CERTIFY that I have no intention to retum to my former domitile, and I int~nd to remain in FORT ~
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~ PIERCE, SAiNT LUCIE COUNTY, FLORIDA, permanently. ~
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. ~ (Name) I
~ ~ - William F Orman
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~ ~~mET~ wbscribed before me this 23rd day of Msrch ~ ~q 70 i
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~ Roc~ romu~s ~
" CIRCUI~ COURT Notary Public
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~ gy D.C. My Commission expires
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~ (To b~ ~x~cut~d in duplicat~ and ori~inal fil~d wNb Cl~rlc pnvit Courf, and duplicab with Tax A~ssor.)
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~ „ ~ gooK 1~3 ~ ~.945
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