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Oeclaration ot Domiclle and Citizenship i
2~ ~84
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORI~A: ~
This is my decla~ation of Domicile and Citizenship in the.State of Florida that 1 am fili~g this day in acoordante and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was fwmerly a legal ~es~denr of ___.P__atterson _ New Jeraey
(City) (State)
and 1 resided at _BB1IDOYlt AV6II11A However I have changed my domivle
- (Streef and Numbe~)
to and am and have been a bona fide ~esident of the State of Flo?ida since ___?~2th___ day of
--,Auguat- t9~Q_, ar,d i~es~de at BidRecreet Mobile Home Park. 1~i~
_ ~ 2251 N. Federa~t ~ighwa~
~ Ft. Pierce .
FORT r1ERCE, SAIN? LUCIE COUNTY, RORIOA
and this statement is to be taken as my declarbtion of citize~ship, actual tegal residence and domicile in the Stete of Florida.
(Insert here any pertinent facts, such as sale of property or business, w relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirements of a leyal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to retum to m former domi 'le and I intend to remain in FORT
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~ PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently.
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~ Francee B.~T~2itie ~ ~oT
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~`'"`~::t},`;; 2251 N. Federal Highway, Ft.PierceFla.
J•''•~'~£t•,~!~• (Address)
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~ "~~:~~~~d~iscribed before me this lOth day of govember ~ 19 TO
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~ ~~C . Notary Public
By ~ D.C. My Commission expires
(To b~ ~x~cul~d in duplicat~ and ori~inal fil~d with Cl~k Grarit Court, and duplicah wHh Tax Ass~or.)
„ - ~ooK 188 ~c~ 361
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