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DECLARATION OF DOMICILE AND CITIZENSHIP
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TO THE STATE AND COUNTY TAX ASSESSOR, t
ST. LUCIE COUN1'Y, FIARIDA
This is my declaration of Domicile and Citizenship in
the State of Florida that I am filing this day in accordance and
in conformity with Chapter 20412 Laws of Florida, Acts of 1941.
I was formerly a legal resident of New York City, New
York and I resided at 303 East 57th Street. However, I have
changed my domicile to and am and have been a bona fide resident
of the State of Florida since Jarniary 2, 1971, and I reside at
3024 S.E. Santa Anita Street, Port St. Lucie, St. Lucie County,
Florida, and this statement is to be taken as my declaration of
citizenship, actual legal residence and domicile in the State of
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~ Florida.
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F I FURTHER CERTIFY that I will register at my local
` address when the registration books revpen, and comply with all
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~ other requirements of a legal resident of this State.
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I FURTI~ER CERTIFY that I have no present intention to
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~ reestablish my former domicile and I intend to remain a legal
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~ resident of and domicile in Port St. Lucie, St.~Lucie County,
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~ Florida.
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~tif : DOROTHY . CLARK
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o ry lic State of orida at Large
= My Co~ission Expires : Z 0 6 0 4~
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` ~0 ~ ~ REXPIK~F~ ~E8 16? 1973 g~1~
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