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Decla~atton ot Domlcile and Citisenship
TO THE STr~TE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this dsy in accordance and
in co~formity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~-~~n Illinoia
(City) (State)
and 1 resided at _ 309 Cypress ~~„~ever 1 have changed my domic,ile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since ~*•r> day of ~
- - , 19
70 , and I reside at Ronte 2 3hannon Drive Lakewood Park ?
(Street and Number) '
;
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and ciomicile in the State of Ho~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of empl9yment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Placing child in pnblic achool - Yelody Hanser
RE~OR~~~
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~ I FURTHER CERTIFY that I will oomply with al) other raquirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ (Name) ~ra Hanser f
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(Address) ~
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~ Sworn to and subscribed before me this 17~ day of APri1 ~ ~9 ?0
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~ . ~1tQG~it PQITRA~~ ~
~ , _ :t~R14 ClRZ~JiT ~ Notary Pubiic
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~ ay = " D.C. My ~ommiuion expires
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~ Rai. ~z , in dupliuM and ori~inal filed whh CIKk Grwit Cour~, and dupljcah witb Tax Ass~stor.)
:g No. i ~ n!~
~ QOOK~04 PAGE ~ .
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