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Declaratlon ot Domicile and Citlsenshlp
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl . LUCIE COUNTY, FLORIDA: ~~v ( ~
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This is my declaration of Oomicile and ~itizenship in the State of Florida that 1 am filing this day in accordance and ~
~n conformiry with Chapter 222, Section 222.17, Florida Statutes_ '
1 was formerly a legal ~esident of _~~~~5 i
h~ _ ~LL j~t1o~__ _
(Ciy) (State)
and 1 resided at __.1~~_~ /¢L /`'1Q1j,_,~} L Howeve~ 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ___QG_~_ Zl day of
~ d C• - . 19__, and I reside at ~ ~ ~F ~ ~ ~ LL1~lrii~'iC
(Street and Number ,f TV ~/j ~ FL~
M~rt~~v` l3~ f
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA A 0 O~ ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. ~
~
(Inse~t here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
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•ocER tarrus
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~ I FURTHER CERTIFY that 1 will oomply with all other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to ~etum to my former domitile, and I intend to remain in FORT ~
~ PIERC~; 5/14NT IUCIE COUNTY, FLORIDA, permanently. _
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~ ~ Swor~~to a~d subscribed before me this ~lO day of ~%'~!c 2c~-~~ , 19 72
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~ ROGER rO1TRAS
tXERK CIRCUR COURT Notary Public
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gy) <.cjcc~"~ '~~'.tl~-c~-~~ D.C. My Commisaion expires
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~ Re b~ ~x~cuNd in dup{iub snd oripinsl ~il~d wilb CIKIc Cira~if Cour~, and duplieat~ with Taoc Ass~ssor.)
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