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DeClaration ot Dott~icile and Cltisensltip
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA: f
This is my detlaration of Domicile and Citizenship in the State of Florida that I am filing this day i~ accordance and
in conformity with Chapter 222, Section 222.17, Ftoride Statutes.
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I was formerly a legal resident of . _ ~ ~v~ ~ " '
- - - - ~Ciy) - (Stste)
and 1 resided at ~ u'~G~ . However I have cfianged my domicjle
- - ! - - -
(Sfreet and Number) -
to and am and have been a bona fide resident of the State of Florida since . day ot
:e ~e~.e~/ Il ~ D i~od' Q.e:~.~-•t/ i~ - f
~-s-- - 19.~ and 1 reside at - - -
~ ~ (St~ and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be take~ as my declaration of citizenship, adual legal residence and domicile in ihe State of Florida.
(Insert here a~y pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
G~2~c-~ ~itLGd.C.-L'~L
f1~E0 ~?ND R~CORDE~
st~ ~pGER PO TRAS~
~~ERVER f1Ep CbUr+"~
AECORp
E8 ~6 9 si ~?~''t 1
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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~ Edward B. Meyer
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~ _ .~h to and subscribed befo~e me this - day of _ , 19 . ~
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~ ROGER POITRAS
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~ CIRCUIT COURT Notary Public
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~ By D.C. My Commission expires ~
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~ (To b~ ~xeeuted in dupliub and ori~inal fil~d with CIKk Grcuit Cour1, ae+d dupliut~ with Tax Ass~stor.)
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