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Declaration ot Domicile and Citize~ship 2~~~'
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. IUCIE COUNTY, FIORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a tegal resident of yO~~'___,;~Qs~e~__
(City) (State)
and 1 resided at ~'?uGd' _ f~o/%1r~.3G _~~d e. However 1 have changed my domiciie
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since ~Q day of
i
~~y~c~ , 19_ ~'O , and ! reside at ___~vG . _ ~'_rh_~T
J (Street and Number)
FORT PIERCE, SAINT tUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment '
at former domicile, removal of family to new dom'scile, purchase of home, etc.) ~
NCn~~~ ?'ca~[. E~ce~.,~Tio.~
2Q4~7~~
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ST.lUC1E COUNTY lA. i
ROCE=, ~01ZRA~~~ f
CIERK CiitCUlt COURT ~
HECOAD VER~~IED S
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FE8 IT I 39 PM'Z ~ ~
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTiFY that 1 have no intentio~ to return to my former domi~ile, and ! intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. BeVeY'ly J. Northrup .
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~ Name)
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(Address)
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" Sworn to end subscribed before me this ~L _ day of , 19~_.
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C GIR~CUIi~CO,RIRT~- Notary Public
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By D.C. My Commission expires _
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(To b~ ~~ld j~lat7~~fiiut~ and original fil~d with Cl~rk Grcuit Cour1, and dupliut~ with Tax Aswssor.l :
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