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Decla~ation ot Don~icile and Cttizenship
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TO TNE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA~ _
This ~s my declaration of Dom~c~le and Citizenship i~ the State of Florida that I am filing this day in accordance and
~n co~formity with Chapter 222, Sect~on 222.17, Florida Statutes.
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I was formerly a legal resident o~rattlebr0_-._ - YeY'mOri~,_ ~
~C;ty~ (State) t
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and 1 resided at 29 Putne~? Ros~ _ . However 1 have changed my domicjle ?
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(St~eet and Numbe~) ~
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ro and am a~d have been a bona fide resident of the State of Flo~ida since _ 28th day of ~
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_ Auguat ~q 71_, a~ i reside at _ 2~9_ __Mninael Port St. I,ucie_____ . _ _ _ ~
(Street and Number) f
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FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence ar.d domicile in the State of Florida_
(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, pu~chase of home, etc.)
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Est~blishing reaidence
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1 FURTHER CERTIFY that 1 will comply with a{I other requirements of a leyal resident of this State.
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~3 I FURTHER CERTIFY that I have no intention to retum to my former dbmiGle, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ ' , (Name) ~
~ . ~ Richard Neil Bryning
' ; (Address)
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Sworn to and subscribed before me this - 24th day of 1~ece~ber 19~1.
4°~`l
ROGHt POITRAS
:~>3 LERK CIRCUIT COURT Notary PuSlic
gy D.C. My Commission expi~es
(To bs exscuted in dupliuta and ori~inal ~ilsd with CIKk Circuit Court, and dup{iuN with Tax Asses*or.)
a~ax198 F~~E109z
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