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Declaratio~ ot Domicil• and Citisenship
i
TO THE STATE AN~ COUNTY TAX ASSESSOR,
S,. ~~~~E ~o~Nn, F~oR~oA: 2a244~ ~
This is my declaration of Oomicile and Citize~ship i~ the State of Florida that I am filing this day in acw~dance and
~n conformity with Chapter 222. Section 222.17, Florida Statutes.
1 was formerly a legal resident of - ~LL°d1~1~ ~ _ ~V O/ S
(City) (Stats)
and 1 resided at -sz~ p~ N P T/ ~ T_-_----. However 1 have changed my domitile
(Street and Number) .
to and am and have been a bona fide residcnt of the State of Florida since ~Q -S~ day of
~~-~-~P~ . 19~11, and I reside at ,Lo~~
9 t~pA[v ~ / JiTP
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY. RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Horida.
(Insert he~e any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
~stsbli.Lin~ r.:ia~enc~ !or ha..st~.a .ou.r~ion
f ~EO ~~o aECOR~e~ ~
s~. ~uc~E cauN1Y ~ ~
ftOGER PO~YR~S
REC~RO YERtf EO COUR
.
D~c 23 It ~z ~M'~~
, 202445
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1 FlJRTHER CERTIFY that I will comply with all other requirements of a le~al reaident of this Sfate.
I FURTHER CERTtFY thas I have no inte~tion to return to my former domiule, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~illiaa ~T. ~iairmo~~ -
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(Address)
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,~:~r.u;.~ .
~ . ~ • . 23 D~o~b~r 70
,;,.~`~wQrn,{d'8qS! subscribed befare me this day of , 19 .
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~ . ~ ~ ~ ~ -=.4 ~v1i1T C~URT Notary Public
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By . ' ~ " D.C. My ~ommission expi~es
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~ (To ex + in dupliut~ and oripinal fii~d whh G~rk Cirwit Cou~f, and duplicat~ with Tax A~s~or.)
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