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o~aluation ot oon+lalt~ ar~ Citis~nshlp ~ 1~~?$~~
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TQ TNE STATE AND COUNTY TAX ASSESSOR,
51 WC1E COUNTY, fIORIDA:
This ~s my dsclaration of Oomiule a~d Citisenihip in th~ Stat~ of Flo?ida that 1 am filinp this d~y in saoord~nu and
,n conformity with Chapte~ 222. Sectio~ 222.17, Florid~ Statut~s. ~
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1 was formerly a legal ~e:~denr of __~$~t ggrtford Connecticut ~
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(City) (Stah)
and 1 ~esided at -94 _ Pl"8tt St2'eet - . However 1 have chanqed my domi~jle
(StreeR and Number) . ~
to and am end hsve been a bona fide resident of the State of Florida since 6th day of i
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,
158 Tunison Ave., Pt. St. Lucie
_ - ~L8}t_--------. 19?~ , and I reside at ~
~ (Street and Number)
f,ORT r1~CE, SAINT LUCtE COUNTY, RORlDA - ` ~ ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fbrida.
~ (Insert here any pertinent fscls, such as sale of propetty or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Children in school, FIl.EO AND RECOROEa
ST. LUCIE COUNTY. FLA.
~ R F C~~ lv~~9 D
R a l p h H. D avis 1 3 yeara of a ge
Deborah Ann Davis 12 years of age 'T~ S~P 8~ 3q
~nnC. ~C?~
. ~lichael Edwin Davia 11 years of age :~0 ~~R r OITRAS
CLERK CIRCUIT COURT .
Raymond R. Davis 8 yeara of age
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1 RIRTHER GERTIFY that I will oomply with all other requir~r~ents of a le~al resident of this State.
I FURTHER CHtTIFY that I have no intention to return to my formar domic~le, and 1 i~tend to remain in FORT
PIERCE, SAINT ~UKIE COUNTY, FLORIDA, permanently. .
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,~~+~~li;?~~tt~,,~~,' ame) 1[rs.
C_ ( ) Beverly Davie
`.~,V.;~..»«.. ~ O~ ~if .
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~t~"•~'f~3~:;~C+~1,`
~ ~'~'..,.;~.a~~,~ ~'P~ 168 Tunison Ave., Pt. St. Lucie
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.~,:j;Y~ ~ (Address)
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~ • ~ibed before me this lat day of September 19~0
~°'j'r~:r~~e„•,.~~ t,` ~
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ROGEt ~OITRAf '
CL~RIC CIRCUR COURT Notary Pubtic' ~
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By D.C. My Gommiuion expires ~
(T~ b~ nc~arNd iu duplieal~ and orioinal fil~i wilh Clrek CkevM Coue~, and dvplieal~ wilh Tax As~or.)
~3 ~186 ~2129 ~
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