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Declaration ot Dornicile a~d Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. lUC1E COUNTY, FIORIDA: -
This ~s my declaration of Dom~c~le and Cit~zensh~p in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 22?, Section ?2~.17, Florida Statutes
I was formerly a legal resident of Sooe!'Y~llt 1b~•
Kity) (Sfate)
and 1 resided at ~ ~antral $tre~t Howevar I have changed my damiCile
(Strget and Number)
ro and am and have been a bona fide resident of the State of Florida si~te ~~b _ day of
. , 19_?0 , and 1 reside at . 8Q~ $Q{L~1l. Q4lM Ih'~~__ .
~ (Street and Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal reside~ce and domicile in the State of Florida.
(Inserl here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of famiiy to new domicile, purchase of home, etc.)
~tering school _ ~
« 'FII.ED~AMD~A~~~~~
S7, WCIE CO
RECORD V~RIFIEO
. . 19~~0
. • -
•TO SEP 3 ~ ~ ' ~ _ _
c~.~v~L
ROGER P~~ RAS
C~ERK CIRCUIT COUR?~
i
~
f
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~ I FURTHER G'ERTIFY that I will comply with all other requirements of a leyal resident of this State.
~
! Ft1RTHER CERTIFY that I have no intention to return to my former domicile, and I inte~d to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FI.ORIDA, permanently.
. ~ ~ -
~ (Name) Ht7in le
~
-
~ • . ~ . . ~ • (Address)
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Swom to~pnd subscribed before me this _~30t~h day of -$l~.4~lt___ , 19-~0_
~ , . .
ROat~R ~O~RAS .
~ C~CUiT COUR Notary Public
B . S~~~ ~.C. M Commission ex ires
Y Y P
(To b~ ~x~cuhd in dupliut~ a~d oripinal fil~d witb qKk C1rcuM Carrt, snd dupliuts with Tax Ass~awr.)
„ °seRK 1~7 ~ 11~
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