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Declaration ot Domicile and Citizenship '
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TO THE STATE AND COUNTY TAX ASSESSOR,
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51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _-SaT~~~~ GeOtB38 ~
(City) (State) j
t
323 North 9tu street ~
and I resided at However I have changed my domitile ,
(Street and Number) ~
.
to and am a~d have been a bona fide resident of the State of Ftorida since ~ 2 th _ day of ~
~
s
~gr~.l ,~9
~0, and I reside at A. B. C. Tatilor COUrt _ ?
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken aa my declaration of citizenship, ad~al legal residence and domicile in the State of Florida.
(Inser! here any pertinent facts, such as sale of property or business, or relinquishment of employment
. at former domicile, removal of family to new domicile, purchase of home, ett.) ~
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Entering Jackie Marie Jones in the lst grade
FILED AND RECOROED
ST. LUCIE COU`~TY F(.A.
• . .^.pRf? y~,-~,~~~.b t
~ '70 APR 30 19~'8~
, PM Z ; 22 ~
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~ ~=r,r.c:.-. ~ Orri~,~s
E CLERK C1RCUfT
~ COURT .
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1 FURTHER ~ERTIFY that I will comply with all other requirements of a legal resident of this State. '
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I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT ;
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ - ~ ~ ~ ~ Donna Jones ( ~drs Jack } ,
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- • ' (Address) `
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~ "•',t 1.~. ~~"'~~~',~,'~it~`d siibstribed before me this 30th day of ~PTil ~ 19 ~0
~ --'.._,..;,~~.Tn~~~=---=----
~
~ ROGER POITRAS
r~ LERK CIRCUIT COURT Notary Public i
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By D.C. My Commission expires i
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~ (To bs ~xecuted in dupliwb and originsl filed with G~rk G~cuit Couef, snd duplicate with Tax Ass~ssor.) i
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