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Declaratio~ ot Domicile and Citizenshlp 191652 `
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORI~A: -
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This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordante and ~
~n conformity with Chapter 224, Section 222.17, Florida Statutes. ~
I was formerly a legal resident of BethlehAm P8.
(Cih+) (Sta»)
and 1 resided at -21_~ASte2' Rd. _ However 1 have cha~ged my domitile
(St~eet and Numbe~)
to and am and have been a bona fide resident of ihe State of Florida since ~ et . day of
Jurie , 19 ~ and I reside at ffidpel Ave
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
. at former domicile, rem~v,~!_of family to new dqmitils, pur4hase of horne: etc.)
residence
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~~'~1N8'R
~T LUCIE cn~~~~~
- RECORO VER~F~E~''~"
'TO MAR 31 AM II: 31
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~~52
; CLERK CIRCUlT COUR°.~
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~ 1 FURTHER CERTIFY that I will oomply with all other requirements of a le~a) resident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domi4le, and 1 intend to remain in FORT
~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. . / ~ /f ~I% /
•i/r~ a~ ~
~ AARR~~B. TAI,ARCZYK
~ (Name)
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_ ~ 1~11 Mapel Ave.
~~L ~~~:-~l~ f;
_ ~-;".,*'.~,~~~~i-C{j ~ G4ddress)
a: r.>. :
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j1r. rF,r:_; 4
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~ •`:~q~ ibed before me this 318t day of Merch , 19 ?
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4^~y(~ _ y%J^.K-r,~ ~ .G •
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~ = _ S~ ~ i ~~C~URT Notary Pubtic
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y~` By ~ r' D.C. My Commission expires
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~ (To b~ ~x~cvhd in duplicah and o~i~inal Rl~d wkh CIKfc Grr~i! Court, and duplicat~ with Tax
s
~ gooK1~~7 PACE~42
~ t~a 13 -
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