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DeClaration ot Domicile a~d Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, S
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Sl. lUC1E COUNTY, FLORIDA: ~
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This ~s my declaration of Dom~cile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter ?22, Section 222.17, Florid~ Statutes.
1 was formerly a legal reside~t of ~cDowell W• Va•
- - (City) (State)
and 1 resided at P' ~~X 1~6 However i have changed my domicjle
(Street and Number) ~
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to and am and have been a bona fide resident of the State of Florida since 15 th - day of
September 19 70 Rt. #3, 556H Box, Ft. Pierce, Fla. ~
_ _ , , and I reside at _ _ _ - - - -
_ _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile in the S4ate 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 domicile, purchase of home, etc.)
Children in school. ~
BRENDA KAY LA&:BERT 10 years of age
PAULA ANNETTA 7~A~iBERT 6 ears of a e F~~ED AND RECOROED' -
Y 8 ST. LUCIE COUNTY, fLA. '
~~CORQ Ve RIFlED
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'l0 SEP 21 A!I II: 16
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I ROGER POl R S
~ CLERK CIRCUIT OUR'C~
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I FURTHER CERTIFY that I will comply with al) other requirements of a iegaf resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and I intend to remain in FORT
PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. r
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, . - r,. PAUL E . LAM?BERT _
~ . . .,`,~c,:,.~ - ~Name) _
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. ~r' ~t : Rt. ~3, Box 556H, Ft. Pierce, Fla.
~ ~ . ~I (Address) - -T -
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~$vv,bm tb ~d'`subsuibed before me this - 21st day of _ SepteTI:beZ'_ _ , ~q 70
Rt~GER rOITRAS -
CLERK CIRCUIT COURT Notary Public
gy D.C. My Commission expires
(To b~ ~x~cut~d in dupliuN and ori~insl ~il~d, with Cltelc Circuit Court, and dupliwt~ with T~x Ass~stor.)
eoeK187 ~AcE 430
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