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Deciaration of Domicile and Citizenship ;
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TO TNE STATE AND COUNTY TAX ASSESSOR, ~a~ ~
S t. L u c i e _ COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of M i a m i , F 1 o r 1 d a , and I
(city) (State)
nsided at _ ^ . However, I have changed my domicile to
(Street a~d Number)
and am and have bt~en a bona fide resident of the State ~ of Florida since day of
january 40 2706 juanita Avenue
, 19__, and I reside at -
F o r t P i e r e e S t. L U C 1 g~S~reet and Number)
, County, Florida,
(c~ty)
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 propert~l or business, or relinquishment of employment at former
domic~7e. removal ot family to ~ew domicile, purcAase of home, etc.)
This is to establish that my dauqhter, BETTY~ JEAN WRIG~HT,
is a resident of.this County.
f ~EO AN~ aECORi~~~ ~
a~.l~yC~E COUNtY LA.
CLEtIR ~?+~C~ COUat G
pECORD Y~Alf1E0
!79
. ~ ~5 ~ lo rn ~ ~
229522
,
` I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
~ comply with all other requitements of a legal resident of this State.
~ 1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
E Fort Pierce St. Lucie County,
~ Florida, permanently. ~
I
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, (Name?
~ aggie L. Wrfgh
- (wadr~~
Sw~n~t~?san~ subscribed before me this 15 day of
, ~3~~~ . . a~~
y!'' ' . .
f ''~~i~ A. D. 19 .
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NotaQ-$iDlic Stste of Flo ' a at LarEe
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~ -.~t'~.C`om~iooM~E~ires
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~'h„~ ~i:~i.<<~:! (To be executed in duplicate and original tded with Clerk Circuk Court, and duplicate with Tax Assessor)
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