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Deciaratio~ ot Domicile and Cit~zenship 219292
• TO THE STATE AND COUNTY TAX ASSESSOR. '
Sl, lUC1E COUNYY, FIORIDA:
Thi: i: my declarar~on of ~omicile and Ctizenship in the 5t~t~ of Florida that 1 am filinq thi~ d~y in acoord~nci ~nd
~n confo~m~ty wi?h Chapter 222, Section 222.17, Florida Statutes.
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I was formeriy a le9s! r~iid~nt of Norfolk ' Yirginia ~
(C~ry) (Stat~) ~
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a~d i ~esided st 9015 Granb~r Street !
How~ver 1 havs thar?q~d my domitiie ~
(Street and Number)
ro and am and have b~e~ a bona fide ~esident of the Stats of Ftorid• :ina lat d~y o~ ~
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T~?~»er~? , 19..~, and I r~sida ~t 614 Ave. I Apt 2
(Street and Numb~r)
FORT PIERCE, SAIN? LUCIE COUNTY, FIORICA
and this stateme~t is to be taken as my declaration of citizenship, actual leqal ~esidence and domicile in ths Stata of Horida.
(Insert here any peninent facts, :uch as sale of property or bu:in~u, o~ relinqui~hm~nt of ~r?pbym~nt
at former domicil~, nmov~l of family ro n~w do~nicil~. purchas~ of hor~e, att.~ -
.Establiehing reaidehce
21929z -
FILEO AND RECpROEO
3T. LIlCIE COUMTY flA.
ROCER pOITRAS
' CIEIIK CiRCUIT COIMT
! RECONO YERIFIEO.~...~~
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f Noy 13 10 w AM 1A1'~
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~ I FUR7HER ~ERTIFY that 1 will oon?ply with atl Qther ~equirem~r~b of • lepa! r~sid~nt of thii SUte.
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~ 1 FUR7HER CERTIFY that 1 have ~o intentio~ to return to my formtr domiGis, and t int~nd to remain in fOitT
~ AIERCE, SAINT LUCIE COUNTY, FLORIDA, p~rmanently.
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~ ~ G~rendol~n Hollomon I,ee
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i~; ~t ' (~lddteu)
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_ ''•y . • •~r` •
_ ' • ~'~rE~~~~''., 23 ~o~ember ,0 1
'bvrorn•fl~'~nd subscribed bafore me this day of
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= ROGER POITRAS
` Ct~tK CIRCUIY COURY Notary Public
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- By D.C. My Gommission expi~et
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('[o b~ oxecutod in dupliut~ and original filod with Garit Grwif CouA, ~nd dupliut~ with Yax Ass~ssora
- a~x197 ~;f1090 ,
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