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Deciaration of Domicile and Citizenship _
TU THE STATl: ANU C:OUNTY TAX ASSESSOR, 2413'76
St. Lucie_ _ _ COUNTY, FLORIDA:
Tl~is is my derlaration ol' Domicilc :~nd Citizensilip in thc Sta[e of Florida th~t ! am filittg this day in
arcor~iance, and in contarmity with Sectior~ ! 7, Florida Stati~tcs.
Weston Ontario
! was formerly a lrgal rrsident ot~ • and [
(CitY) (Stat~)
r~sided at ~ Tampa Terraee However, 1 have changed my domicile to
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(Strret and Numt~r)
;~nd am and have becn a bona tide r~sident of the State oi~ Florida since 1 _ day ot
November ~ 69 141 NE Airoso Bivd .
- . 1 ) . and I residr at _ - - -
(Stteet a~d Number)
Ft. Pierce St. Lucie County, Fiorida,
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~nd this statement is to br tahen as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insrr. hrr,r any prrtinent facts, such as salr of ptopettY or businrss, ur relinyuishment of rmptoyment at former
domicile, remo.al af family lo new Jomicile, purchaxe of homr, rtcJ
t LE~ AMO RECqRDE ~
f~, l~Ct~ COt1NTY fL~. a,
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I Ft,~RTHER CERTIFY that 1 will register at my loral address whrn the registration books reo~en, and
' romply with all othcr requirements ei a lcg~l resident of this State.
1 FURTHER ('ERTIFY that 1 ha~•e no intention to return to my fornier domicile, and I intend to remain in
Ft. Pierce St. Lucie Coimty,
, - - - - - -
. E=lorida, permanrntly. ~
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_ __l.~%~~d~~~i- _
Dav d Walter Sehin~Na"'e~
- -
, (Addtess)
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I Sworn to and subscribed beforr mr this _ 4~__ day of '
;
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' ~~~~11~!P'~- - A.D. 19~
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' . a"ry Public State ut Flurida at c M~
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: ~ ~ h1~r Cort~nis9ion expires----------
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(To be rxrcuted ~n duplicatr and uriginrt filed with Ckrk Circuit Court, and duplicate Kith Taa Assessor)
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