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Declaration ot Domicile and Citizenship 2~3~~2
TO THE STATE AND COUNTY TAX ASSESSUR, i
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Sl. IUCIE COUNTY, FLORIDA• ~
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This is my declaration of Dom~cile and Citizensh~p in the State of Florida that 1 am filing this day in accordance and E
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~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was forme~ty a legal resident of !l. ~'f ~ 4_~~_~~? _ _ _~P _ - ~
(City) (State) I
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and I resided at 3 _ a.L~,~___V_ _ However 1 have changed my domiu~e ~
_ (Street and Number) ~ ~
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to and am and have been a bona fide resident of the State of Florida since ~ f _ _ _ day of
_ f l~/ , 19_ 7~, and ~ reside at _ l~ 1 A P/ v=~ -
(Street and Numbet)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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 employme~t
at former domicile, removal of family to new domiciie, purchase of home, ett.)
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RES IDE:•~ CE ~
223'7~2
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~ ~ ~ lE0 AkD RECp~
~ 111C1E COUNTY
~ ROv"ER
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; CIERR CIi~~T COy
~ ~lECORp YERIFIEO '
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~ ~ 11 !I 3c Ay'Tl ~
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? I FURTHER CERTIFY that I will mmpty with all other requirements of a legal resident of this StatB.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiule, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. i
~ JOYCE PA ~
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~ (Name)
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<<~t ~ ~ ~ i~w+r~~~
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~ , 111 Hialeah A~e. , Ft. Pierce, Fl.
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' f, i[,J,'•.. . ~';•~~,~j. _
. ~ ` , ~ - (Address) 334 50
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~~~•~Swor"r~ to and ~ihi~bed before me this ~ th day of _ F6b2"LiBT~I , ~q~_.
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~ . P.~~?S -
;r~ CLERK CIRCUIT COURT Notary Public -
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~ By ' _ _ D.C. My Commission expires
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(To bs executed in duplicats and oripinat ~iled with G~rk Grcuit Court, and dupliuts with Tax Assessor.)
~ N, A BoaK 199 P,,~E 1774
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