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Declaratio~ ot Domicile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA: ~1~5~~ ~
,
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This ~s my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordante and ~
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes. -
I was forme~ly a legal resident of G~!1 ~l /!~•~ia~
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. ~ (City) (State)
and 1 resided at a. - . However 1 have changed my domiGile 1
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(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since _ jf.~N!I~L _ f--- ~`_~L--_ day of ~
v
. , 19~1 _ , and I reside at - --~~OS_ ~ a'l~~[- - - ~
_ L%yL..~~1YLL f -
(Street and Number)
FORT PIERCE, SAINT LUCIE 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 facts, s~ch as sale of property or business, or relinquishment of employment
at former domicile, removal of family !o new domicile, purchase of~home, etc.)
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Eatablishing residence
FfLEO ~?M~ itECQRDEO ~ i
~ st.~.uc~c ~ouMnr fu.
ROtf R P017RAS
CLEIIt C1kCU17 C~i1RT
IlECORD YfRtF1E0
Auc 30 3 47 ~~T i ~
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! 2148~2
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
! FURTHER CERTIFY that I have no iniention ta return !o my former domicile, and ! intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly. ~
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r,dna ~earce i
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`W° 1 ~O S ~ ~
~ (Address)
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Sworp,lo•~bsCr~ed before me this day of ~ . 19L~• {
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~f'~r:•:r :
"~`~ro~.:• ;
~ CIRCUIT CQtf~' Notary Public (
By D.C. My Commission expi.?es
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(To b~ ~ii~1~d in duplicat~ •od ori~inal ~il~d witl~ G~rk Cirwit Court, and duplicat~ with Tax Ass~stor.)
eoac195 r~ 59$
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