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O~cla~ati~ o! Domlall• and Cltis~nahip ~
TO THE STATE AND COUNTY TAX /ISSESSOR,
51. lUC1E COUNTY. FlOR1~A:
This i: my decl~r~tion of Oomicil• ~~d Citinnship in ti~ St~t~ of Florid~ th~t I am filinq this d~y in aoootd~ntr end
~n confo~mity with Chspter 222, Settion 222.17, Flo?id~ Statutes.
1 was forme~ly a ie~si ~e:~t of _dsf~e.~cs_o~ixille Indiana _
(City) (St~»)
and 1 resided at Silvet`_ I.akeB EStelte Rt 3 . Hcwevsr I h~ve chan~ed my domkile
(Shest and Numbe~)
to and am and have been a bona fide rosident of the Stats of florida since 18 t day of
- - July ,~9 7Q and I ra:'ide at Rt 4 Box 188-B
' (Street and Number)
f~RT r1~CE, SAINT LUCiE COUNTY, RORIDA - ~
and this statement is b be taken as my daclaration of citizenship, actual legal residence and domicile in the Staro of Horida.
(Insert he~e any pe~tinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domiale, purchase of home, etc.)
Establishing reaidence 2U3.~,3'~
s~°u~"o
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I RlRTHER CERTIFY that I will oomply with sll other requi~eme~ts of a le~al ~esident of tfii: Stah. -
1 FURTHER CERTIFY that I have no intention to retum to my formtr domitile, and f intend to remain in FORT
PIERCE```SA~~T~j~~1~~.CdIINTY, FLORIDA, permanently.
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L! 1~ OG A. (Name)
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- ~;~vs _ 8oy H. Danner Sr.
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~ ~ 25th January ?1
~ Sworn to and subscribed befare me this day of 19 .
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~ ROG~R 'OtTR/1S
~ GRC R COURT Notary Public
c~e~l,.c~L- ~
~ B 0.C. My Commiuion expires
~ Ro b~ ~c~cuNd in dupliuh and orisinal At~d wilh Cl~k q?a~it Carrt, and d~plicah wilb Tax A~~a
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