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Oeclaration ot Domicile and Citisenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FIORIDA:
This is rc~y declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Floride Stetutes.
1 was formerly a legal ~esident of POrt Arthur Texas ~
• ~ (Ciy) (State)
and 1 resided at _._-??S8____ 618tTe@t However 1 have changed my domici~e
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since llth day of
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April , 19?~ , and I ~es~de a~ 2112 Golfview Court
(Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citi=enship, actual fegal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property o~ business, or relinquishment of employment
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at farmer domicile, removal of family to new domicile, purchase of home, etc.)
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Entering Deborrah in the 4th grade _
Donna in the 3rd grade
Danette in the lst grade
'i FILED ~AND RECOROEDI_ , ~ :
i ST.~LU~O~''J ~U~ ~~EOLAt ~
~ 192U`~~
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~ 'TO APR I 3 AM 9~ 54 ~
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~ f, f? ~ F?; ;-t~ITR:.S 1
CLERK CIRCUIT COURTR ~
I FURTHER CERTIFY that t will rnmply with all other requirements of a(egal resident af this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ;
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4Cp''~., ` X ~ Zti L~ 'j~'% ~ ;
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.,..,~.i>~~~~ ' G~''~i;:~` (Name) i
' v.~'`~'~~ ='t~'a':~ Barbara Davenport (~drs Robert ) i
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~ Sworq .tq,a~-su#lscribed before me this 13~- day of ApTil , 19 70 . ~
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~ - ROGER POITRAS ~
~ RK CIRCUIT OURT Notary Public
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Sy D.C. My Commission expires ~
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~ (To be executed in duplicats snd original filsd with Clerk Grcvit Cou~, snd duplicat~ with Tax Assesfor.) ~
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