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Declaration ot Dornicile and Citise~ship ;
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T~ THE STATE AND COUNTY 1'AX ASSESSOR, ~ E
51. IUCIE COUNTY, FIORIDA: ~
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This is my declaration of Oomicile and Citizenship in the State ot Fto~ida that I am filing this day in acco~dance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
I was formerly a legal resident of __~~land _ _ _ Ind. _
(City) (State)
2b04 River Drive
and 1 resided at However I have changed my domiCile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida si~ce _ A~ril _11~1@~9 day of
. 19---, and I ~eside at 607 Holley Ave.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
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snd this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
$i~~ac ~sxis~ cx Entering children in public achool
' Michael and Patricia Kirby
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~ FILED AND RECOROE6'
ST. LUCIE COUt~TY, FLA.
s • PECOR7 V~itIFl~p ~
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'70 APR 13 AM 8: 24 ~
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CIERK C:RCUlT COURT~:
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; 1 FURTHER CERTIFY that 1 will comply with all other requirements of a lega) resident of this State. ~
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~ I FURTHER CERTIFY that 1 have no intention to ~etum to my former domicjle, and I intend to remain in FORT ~
; PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently.
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? (Name) Carol evyak
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(Address)
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Sworn to and subscribed before me this 13th day of April ~ ~q 70 ~
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~ ROGER . POITRAS, . .
. CLEItK GIRCUI? t`~URT Notary Public
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's gy " D.C. My Commission expires
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3 (To be executed ~ ie duplicaM s~d onSinal ~il~d with CI~?k Circuit Couirf, snd dupliut~ with Tax Ass~swr.)
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~ BooK1~3 PACE2931
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