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Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~ 2189~~
Sl. lUC1E COUNTY, FIORIDA:
This ~s my declaration of Domicile anr! Citizenship i~ the State of Florida that I am fili~g this day in accordence and
~n conformity with Chapter 222. Section 22~.17, Florida Statutes_
I was fo~merly a legat resident of FOrt WOTt$ _ 1'@Xaa___
(C;Ty) (State)
and 1 resided at 4027 SCTLigga DZ'1V@ However I have changed my domiCile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since ~ 5th - _ day of
November , ~9 , and I reside ar _ _ ~ 18 West~len Dri~e _ _ _ _ _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA .
and this sta~~T~ent is to be taken as my declaration of citizensh'sp, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of properry or business, or relinquishrnent of employment
at former domic6le, removal of family to new domicile, purchase of home, etc.)
Carol Hill 13 years
Alice Hill 8 ~ears ,
1 F
FIlEO AND RE~Q_RQEB ~
ST. ~uC1E tOUNTT f~A,
AOCER POITR~B t
CIERIt CtRCUIT COi1RT ~
IIECORO VERIFtEO.~,~.,~~ ~
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I FURTHER CERTIFY that I will comply with al) other requirernents of s leqa) ~esident of this State.
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I FURTHER CERTIFY that I have no intention to retum to my former domicile, and I intend to remain in FORT
~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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~ (Name)
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- lCre. SY. V. Hill -
_11~~e t n ~iv_~-----
~ (A~dress)
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, Swort~ to and subscr~bed before me this day ot -------~~'_~~'-t!Y~2~C.C.~ ~ ~q~
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~ . ~ ~ER ro~ - -
::r' : .p~RK CIRCIA~ OURT Notary Public
By ~ D.C. My Commission expires
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(To b~ ~x~cut~d in dupliut~ and ori~inal ~il~d with Cl~ric Circuit Court, and dupliut~ with T~x Ass~swr.)
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~ ao~K 197 F~~E 63' ~
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