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Declaration of Domicile a~d ' 'zenstwp
TO TNE STATE AND COUNTY TAX ASSE.SSOR,
3t. _ I~u01e _ ~-pUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship i~ the State of Fiorida that 1 am fding this day in
acconiance, and in conformity with Section 2'2.17, Fiorida Statutes.
i was formerly a legai resident of CDLLI~O~SSE(J,C%301~ COUl~i`Z) 8. C. and [
tt1~y) (sa~e)
rt:sided at ~z 33 . However, 1 have changed my domicile to
(Strest aaQ Num~) -
end am and have been a bona fide nsident of tfie $tate of Florida sinoe ~ 8~ day of
Jiigu~~t g 6_ T, and 1 reside at 502 I[a]rll. owe= I;~u~e ,~t . Pie r~ e,~la.
(saaec y.a H..eer)
!'ort Pierse . 3t. Zuaie County, florida,
(Cltr)
and this statement is to be taken as my dectaration of citizenship, actual lega~ residence and domicile in the State
of Fiorida.
(lnser~ 6ere aar pert~ent fscts, such as sale d propert7 ar b~, a ~e~ue\~e~t oi ewpioYoewt at fot~er
domicie, rnaoral of fa~ilp to nevr dominle. P~rc4ase ot ?omr. etc.)
Thi• ia to certit~ that 8ebecsa PQgdergrait hn~ been a leaal
ro~idenee o! St. Lueie Connt~, 1'lorida ~isso 18 ,naust 1967.
st.u~~~'~~~ ~ ~
f.'IE~C
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Ed.r•~"~
RE~ORO
~ Z apP~1'~Z
~7595
1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State_
~
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~ I FURTHER CERTIFY that I have no intention to return to my former domirile, and I intend to remain in
f
` !'t. Pieree - 3t. Ltisie , County,
` Florida, permanently. ec'~r) . ' - L
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~ '~"ij,~ _ l[II3. $SRaER! Pffi[DEBGRA!`i
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y~~p °fi` ~ ' _ (w.e)
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t . ; 5~2 l[a~t10~6I' I~aA6
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. , ~a~;~~ l~ort Pierce, (~~la.~ 33450
` • S~rp~u.tp Y:. ~ before me this _~~.'~Sday of
; :
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Y • ! • ` -
~ A. D. 19-.~2_
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~ POITBL?~, ClerY Cireuit onrt
; : t.~: , ~lt~t. "
~ ~ BZs D.C.
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k (To be e:anted o d~plicate aad ori6iwal f~ed w~itM (]e~k Circ~iR Co~ri, a~d d~piicate w~iti Tat Assasot)
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