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Declaration of Dornicile and Citl:enship
TO THE STATE AN~ COUNTY TAX ASSESSOR. 220589
Sl, IUCIE COUNTY, FLORIDA: ~
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This is my decla~ation of Oomicile and Citizenship in the State of Florida thst I am filing this day i~ acoordancs and
~n conformity with Chapter 222, Sedion 222.17, Florida Statutes.
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1 was formerly a icgal ~es~de~r of Ar2in~ton V8. _
(City) (State) t
and 1 resided at _261? _ 1~OTth StHtlrt Street _~Wever 1 have changed my domicile ~
(Street a~d Number)
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ro and sm and have been a bona fide resident of the State of florida since _12th day of ~
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Au at____ 71 _ 153 Rio ldar Drive ~
, 19__ , and 1 roside at
(Street and Number) i
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~ART PlERCE, SAlNT LUCIE COUNTY, FLORIDA ;
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and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida. ~
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(Insert here any pertinent fads, such as sale of property or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
_ 220589 ;
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Establi~hing reaidence ST.~~sER fOTRA~i~A~ '
CLERK C~iiCWT CWIIIT
~e~nen vco~r~en~~
O~c 15 2 09 PM't I '
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~ I FURTHER GERTIFY ihat I will comply with all other requirements of a layal resident of this State. ;
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~ I FURTH~R CERTIFY that 1 have no intention to return to my former domiqle, and 1 intend to ~emain in FORT '
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~ ~IERCE, ,S~~j~LUCIE COUNTY, FLORIDA, permanently.
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- . (Name)
3 ' ~ - Paul T. Glenaon
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. = l~erle A. Gleaaon
- 15th December 71
Sworn to and subscribed before me this day of , 19 .
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ROGER POITRAS
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3Y K CIRCUIT COURT Notary Public
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~y D.C. My Commission expires
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(To b~ oxfcut~d in dupliut~ and oripinsl fil~d with Clsrk Grcuit Cowf, and duplicat~ with Tax Ass~swr.j
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