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Deciaratlon ot Domicile and Citiz~nship
TO THE STATE AND COUNTY TAX ASSESSOR. ~v
Sl. lUC1E COUNTY, FIORIDa:
This is my declaration of Uomicile and Citizenship in the State~of Florida that 1 am filing this day in eccordance and
~n conformity weth Chapter 222, Section 222.17, Florida Statutes. "
1 was formerly a legal ~esident of ~eWBrk Delaware
- - -(City) (State) ;
and I resided at ~5 1de8d01I~ L8II@ However I have changed my domi~ile ,
_ (Street and Number)
to and am and have been a bona fide ~esident of fhe State of Florida since 15th - _ day of
September _,~970_, and I reside ar _315_ No._27th. Street. ;
(Street and Nurrsber)
FORT PIERCE, SAINT LUCIE COUNTY, FLORiDA ~
and this statemenf is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(I~sert 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 af home, etc.)
!
~
FILED AND RECOROED +
LORI I,YNN RACE 9 years of age ST. ~UCIE COUNTY. FLA. ~
~?cCQRD VERIF~EO
LINDA DIANE RACE 7 years of age
'l0 Sf ~P 1~6 A
M~
I
O: 2 8
~
RO ~ER POITRAS
. CLERK CIRCUIT COURT
~
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k
~ Cnildren in school ~
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I FURTHER CERTIFY that I will aomply with all other requirements af a leqal resident of this State.
I FURTNER CERTIFY that I have no intention to return to my former domiCule, and I intend to remain in FORT
PIERCE, SAINT LUClE COUNTY, FLORIDA, permanently.
~:ii::~?3ttl.r~~j~~, . ~~Lt ~/~i~C-~
~``~v r.~~~'~ ~'•%i. BETT L. RACE .
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,~r~•~,5~%~' ~~G (Name)
= = . jc~•. ~ ;
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_ ~C~~:t.~~t~' ~ ~ r ~
~ - ' - 315 No. 27th. Street
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' ~ (Address)
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16th Se tember 70
1~I~Wt~~t~,snd subscribed before me this _ day of p_______ , 19
~ ROGER 'OITRAS -
CIRCUR COURT Notary Public
.
By _ D.C. My Commission expiros -
Re b~ ~x~cvt~d in d~pliut~ and o?iginal Hl~d with Cl~rk Ci?cuk Courl, ~nd duplicah with Tuc Asa~ot.)
,3 BQOK~87 ~~E ~~2
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