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Declaratio~ ot Domicile and Citisenship
1~~3,~E~3
TO THE S~ATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accorda~ce and ~
~n conformity with Chapter 422, Section 222.17, Flo~ida•Statutes.
I was formerly a legal resident of _ AZ'~~~'A_____ _ _ _ _ _ ~Q~~---- - - -
~C~ty~ (State)
and I resided at _1775_ COO1@dg@ R08d_ Nowever I have changcd my domicile
(Street and Number)
?o and am and have been a bona fide resident of the Stete of florida since 25_th day of
~
~
ALtgu~ t 1910 , and I reside at __3115 S O. 22 nd . S t. ~
~ (Street and Number) }
t
FORT PIERGE, SAINT LUCIE COUNTY, fLORIDA `
and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile ir. the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domic3le, purthase of home, etc.)
FRANKZIN J. VARSON 3R., 14 years of age
;
BRIAN KEVIN VARSON 10 years of age
KI~iBERLY DENISE YARSGN 9 years of age fILEO AND RECQR~ED ;
S7, lUC1E COUNTY. FLA. ;
I~~.CORD V`-R~r~Kn t
~.~5;"~fi3 ~
'10 SEP I7 PM 2: yZ
~--c.~~c ~
; c-<~GER ~~TRAS
~ CLERK CIRCUIT COURT
~
~
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r
I FURTHER CERTIFY that 1 will comply wilfi all othe~ requirements of a IeQal resident of this State.
t FURTHER CERTIFY that I have no intention to return to my former domicrle, and I infend to remain in FORT
PiERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. ~
(~~i 7~~
CAROI,YN VARSC~N
(Name)
3115 So. 22nd. St, Ft. Pierce, Fla. {
~ -
(Address)
Swom rp>aadaYburibed before me this - 17th _ day of SeD~~~gT_ - , 191Q_.
`
_ . ,
~ -
-ROOE~" rOiTRAS ~ : - -
: CtHtK CIRCWT CO(1R~ Notary Public
gy , ~ ~.C. - My Commission expires
, :~°C~
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•
yr ~t s T •l
. (To b~ ~ir~wl~d'in d~ptiut~ aod original ~il~d witl+ Gsrlc Grcuit Couh, and dupliuh with Tax Ass~ssor.)
eoo~ 187 ~rE 2~6 ~
No. 13
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