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Declaration ot Domicile and Citizenship .
• TO tHE STATE AN~ COUNTY TAX ASSESSOR, ' ~1~2 '
Si, IUCIE COUNIY, FLORIDA:
Th~s is my decla~ation of ~omicile a~d Citizenship in the State of Florida that 1 am filin9 this day in aao~danu •nd
~n conform~ry with Chapter 222, Sect~on 222.17, Flo~ida Statutes.
t was formerly a legal resident of H3Aid81@ , N@N gB~DShir~_ ;
(City) (Stat~)
end ! resided at P• BO]c # 176 1{cwever I have chanyed my domic~le'
(Sireet and Numbe~)
to ar~d am and have b~en a bona fide resident of the State of Florida since 7t~ day of
Decenber , t9~, and i reside at 549 Fl~~" .sts nr~vP pr~rt ~t. Zuc:i~
(Straet and Number)
FOR? PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicite in the Stata of Fbrida.
(Insert here any peninent facts, such as sale of property or busineu, or retinquithment of ~mploymsrtt
at former domic+le, removal of family to new domicile, ~urchase of har?s, etta -
Enteriag c~ildren ig ~chool ~
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6th ana 9th ~radea .
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T~~~E~ ~ 1!~
; ttOGEF 0 !
; ~ CLERK C~RCaNt 64U1~
; RECOR4 VEatF1E0
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~ t FURTHER CERTIFY that I witl oomply witfi al) othsr roquirements of a lefla! resident of this State.
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I FURTHER CERTIFl( that I have no intention to retum to my formar domiale, and 1 intend to ~emain in FORT
PIERCE, SAINT LUC1E ~OUNTY, FIORIDA, permanently. ~
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~ ~tr, ~ ry.z~-v ~ ,
• ~ ~ , . (Name)
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- - Tho~as A. Baaha~r
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. _ - ~ Janet Bashex ,
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~ T Sworn to and subsu~bed beforo me this ~f~ day of ~~s-• , 19~_~ ;
ROGER POITRAS
~ RK CIRCUIY C URT Notary Public
L, ~-C.Z~~
8y D.C. My Commission expires
' (Yo b~ oxecutod in dupticata and oripinal filad with Gark Grwit CouA, and dupliut~ with Yax Ass~ssota
~i97 ~~356 .
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