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Declaration ot DomiCile and Cit~zenship .
TO THE STATE AND COUNTY TAX ASSESSOR. 21~~0
Sl, lUC1E COUNTY, FLORI~A: .
This ~s my dedaration of Oomicile and Citizenship in the State of Florida that I am filing this day in actordante and
~n conformity with Chapter 222. Sectio~ 222.17, Florida S s.
1 was forme~ly a legal resident of -
~C;~y) (Stats)
nnd 1 resided at _ ~ _ . _ `+~r.~'~A-_ - - • Ho ver have changed my domiCile
(Stroot and Numbor)
~o end am and have been a bona fide resident of the State of Florida si~ce 1 day of
_ ~ _ , 19___, and t reside at. ' ~
(Stree and Number)
FOR? PIERCE, SAINT LUCIE COUNTY, f10RIDA
1
and this statement is to be taken as my declaration of citizenship, actual legal reside~ce and domicils in the State of Ho~ida. ;
(Insert here any 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.)
Sandra Dee Hall ST
LUCiE COUNTY f~A.
ROCER POITRAB ~ ~
CIERK CtRCU1T
COU~C~
RECORO YEFIFIEO
S~ 15 9 ~ AM'?I
' 215600
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1 FURTHER CERTIFY that I will comply with all other requirements of s leya) resident of this State. ~
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! FURTHER CERTIFY that I have no intention to re n to m form r domiCile, and I i tend to remain in fORT
F~ERCE, SA1N7 LUClE COUNTY, FLORIDA, permanently. ;
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(Name
riae C. Ha
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~ Swoi~A~~b "aiid. subi~fibed before me this ~ s day of Septesber ~ ~ 9 T1
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~ ~ - ? ~ :ROGER , L'~t~J r
~ i~El~l~~ 1Jl~;'~i'ftlRT Notary Public
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;.~•,i, .,.r.
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2y D.C. My Commission expires
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(To b~ ~x~cut~d in dupliut~ and ori~iAal filed wjth Cl~rk Ci~cuit Court, ~ed dupliut~ with Yax Ass~sso~.)
600K 1~a7 PAC(',~1~
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