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Decl~ratio~ ot Domicile and Cittzenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. WCIE COUNTY, FtORIDA: '
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This is my declaration of Domicile and Citizenship in the Sta:e of Florida that 1 am filing this day in accordance and ~
~n confo~mity with Chapte~ 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of Betsv L~ne _ Re~tUC$~ j
(Ciy) (State) ~
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and 1 resided at . However 1 hsve changed my domiti~e
(Street and Number)
to ar?d am and have been a bona fide resident of the State of Florida since day of
August 69 336 Barclough Street
_ , 19 and I reside at -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this stateme~t is to be taken as my declsration of citizenship, acriral legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, suth as sale of property or business, or ~elinquishment of employment
at fo~me~ domicile, removal of family to new domicile, purchase of home, etc.)
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Eetablishing residence and epplying for homestead
FILED ANO RECOROED`
3T. LUCI~ COUNTY. FLA.
~~COR~ VERlFt~O
. ~91639
'T0 MAR 31 AM 9: 42
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~ R0: E~C pptTR~,S
` C~ERK CIRCUIT COURT'
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~ 1 FURTHER CERTIFY ihat I will oomply with all other rsquirements of a leyal resident of this State.
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~ I FURTHER CERTIFY thai I have no intention to retum to my former domiCile, and I intend to remain in FORT
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~ PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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• . ti~•= cG~ , i ~ (Name)
~ -,':p~~'~~.,'!':"~~1~,p~.~: Garlin Vance
~ ,t:: }i .t_"- ~i31~~ ri i ;i. = .
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~ ~ G' 31 Merch ?0
~ Swor~rYd~and suburibed betore me this day of , 19 .
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~ ROGER rO1TRAS
~ CIRCU COURT Notary Public
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~ By O'L~~GLC/ D.C. My Commission expires
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~ Ro b~ ~x~cut~d In duplicat~ and ori~inal fil~d wilk Cl~rlc Gnvit Car~f, and duplicat~ with Tax Aa~.)
~ B~oK 1~3 ~21
~ ~a. ~ 3
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