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Declaration ot Domicile and Citizensh~p 226~
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIOA:
This is my dedaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
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~n conformity with Chapter 222, Section 222.17, Florida Statutes.
Nichols~ille . ~K
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I was forme~ly a legal ~esident of _ _ _ _ -
(City) - - (State)
and I resided at 504 NOttgNAy However 1 have changed my domiGile
(Street and Number) ~
Xarch 23
ro and am and have been a bona fide resident of the State of Florida since - day of ~
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123 Aldea Court i
_ _ _ - 19_7 2, and I reside at ~ - - _
' (Street and Number) ~
Port St. Lucie, Fla.
FORT PIERCE, SAlNT LUCIE COUNTY, FIORIDA
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
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at former domicile, removal of family to new domicile, purchase of home, etc.)
Jeifery Blankenahip
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Cl.ERK C~aCWT COU~T c ~
RECORO VERtFItO~ ~
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~ I FURTHER CERTIFY that 1 will comply with all other requirements of a lega) resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and 1 intend to remain in FORT
~ PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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s . ack Blankenahip
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~ SyyOtr~~nd subscribed before me this day of , 19y-"
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~`n ~ ROfiER POITRAS ~
CLERK CIRCUI COURT - Notary Public
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5~ By ~ D.C. My Commission expires
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(To bs ~x~cut~d in dupliwte and oriqinal fil~d with Cltrlc Grcuit Court, and dupliut~ with Tax Ass~ssor.)
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