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Declaration ot Domicile and Citizenship s
TO THE STATE AND COUNTY TAX ASSESSOR, ~
2~125~ E
Sl. WCIE COUNTY, FIORIDA: ~
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This is my declaration of Domicile and Citi2enship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of _ _~~~1~'~QL21- _ _ _ . _ - ±
(City) (State) ~
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3581 Village Drive
and I resided at _ _ . However 1 have changed my domicile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since _ . l~t day of
NQVeIl122er 19___?1, and 1 reside at _Ap~~47 Bay~hOr _ nr ve
(Street and Number)
FORT PIERCE, SAINT IUCIE COUNTY, FLORiOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and 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, ~emoval of family to new dorrsicile, purchase of home, etc.)
Establishing reaidence
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; ~ILEC ~kp F;~pRDEO
~ ST. LUCIc: CO;IMIY FIA. ~
; ROC?y POITRAS ~
? CLERK t - !
i RFrrA~ Y; F~ ~C COURt !
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~ I FURTHER tERTIFY that I will comply with all other requirements of a leyal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiCile, and 1 intend to remain in FORT
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PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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- ~ ~ (Name)
~ . ~ Ray E. Minter
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~ _ Florence I,. Minter
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: Swom ~to e~d subsuibed 5efore me this 30th day of _ December ~~9 71
ROGER POITRAS -
_ K CIRCUIT COURT Notary Public ~
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~-3 By `u~~-~ 'E~~r D.C. My Commission expires ~
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:;y (To b~ ~x~cut~d in duplicat~ and oripinal ~iled with GKk Grcuit Court, and duplicat~ with Tax Ass~ssor.)
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