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Declaration ot Domicile and Citizenship
(O THE STATE ANO COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
Th~s ~s my declaration ot Dom~cile a~d Cit~zenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter Section 222.17, Fiorida Statutes.
I was formerly a legal resident of Ceder R~9p~.ds-- - -Iow~-
~C;ty~ (State)
and I resided at Aou4e 1 _ However I have changed my domi~ile
(Street and Number) `
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!o and am and have been a bona fide resident of the State of Florida since Sept,eolbeP 2Y _ day of
, 19_ TO , and 1~eside at 6347 Sot~h F'~dsrsl Hi~hrsv
(Street and Number)
i~R? PiERCE, SAiNT tUC1E COUNTY, FLORIDA
and this statement +s to be taken as my declaration of citizenship, actual legal residence a~d domicile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
Terrp and Sherry i;~ssler FILEO~ANO RE~ROE~t
ST: LUCIE COUN Y. FLA.
R~COR^ VEftIF!FD
1~b~s;
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i~U JGf ~v R1 V•~~ f(Y
C
i~OGER POITRAS~ ~
CLERK CIRCUIT COURT,; ,
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i Fi1RTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ,
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I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) Elaine Kessler
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~ (Address)
~ ~ ';.tii?;.:,,~::~,,f rN . 28th Septesber
~ ~~i.~pm~'7yt~kjbed before me this day of - , 19?~__.
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~ Nota y Public -
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~ BY ' . ' ~ ~ - - D.C. My Commission expires _
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(Te b~ ~x~cubd in dvpliu9~ and oripinal fil~d with G~?k Urcuh Cou~f, and dupliut~ wifh T~x Ass~ssor.) j
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