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Declgration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ~C~t7 I~O
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in atcordance and
~n conformity with Chapter 222, Sec:tion 222.17, Flarida Statutes. ~
1 was formerly a leqal res~dent of . _ SQIItetl_RSl~~.4~i0Q . _ _ ~aL_ - -
(City) (State)
and 1 resided at 12_ PleBSau{~_$~i'ee{~ _ . However 1 have changed my domiCile
(Street and Number)
!o and am and have been a bona fide residsnt of the State of Florida si~ce 3epte~ber 15 day of
_ _ , 19~4. , and I reside at _ - - - - ~~jQQ -~e -
~ treet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employmen'
at former domicile, removal of family to new domicile, purchase of home, etc.)
Colleea aad Shawn 0~Neil ST L~CANp
RECOR1j VN~•
~~~~20
70 SEP 2Z AII B: S~
ROGER
CLERK C!R U T COURTJ
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' I FURTHER CERTIFY that 1 will comply with all other requirements of a legat resident of this State. i
~ I FURTHER CERTIFY ihat I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
y' , ' ~
~ (Name) ' ~
~ .Tohn O~Neil
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. (Address)
~ Sworn~ ` bscribed before me this day of _--~Dfc~~~L _ , 19.3~
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' Notary Public
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B~ r ~ D.C. •My Commission expires
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11 ' ~1e duplicat~ and oriqinal filed whh Cl~rk Circuh Cour1, and dupliut~ witk Tax Ass~ssor.)
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