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Deciaration of Domicile and Citizenship
2S4230
TO THE STATE ANU COUNTY TAX ASSESSOR, ~
_ St. Lucie _ COUNTY, FLORIDA:
Tliis is my deciaration oti Domicilc and Citizenship in the State of Florida that I am filing this day in ~
acconlance, and in conformity with Sec:tion 222.17, Florida Statutes.
1 was Cormerly a legal resident of Miami , F1Q.rida ~ and I
(c~~r) ~si.~~~
n;sided at - p.O~Box 3~7 bQ____. . However, 1 have changed my domicile to
_ (Street aod Number)
and am and have bec:n a bona fide n;sident of the State of Ftorida since day of
, 19__S3 , and 1 reside at Ft. Pierce Hotel
~ (Street and Number)
Ft. Pierce St. Lucie County,Florida,
(c~tr f . i
;
and this statement is to be taken as my declaration of citizenship, actual legal iesidence and domicile in the State j
of Florida. '
I
(Inseri here any pertinent tacts, such at sale-of propcrty or business, or relinquithme~t of employment at formet
domicile, removal o! family to new domicile, purchase of home, ete.)
- 254230
ST«~
~ ~qU~jTY FLA 1
Establishing residence C~ RKCCR.~~~"'tR~s ~
RFCORZ COURt
~ YE1rF1E0.~„~„~
. M~r I I IZ o9 PH'73
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~ ~''°-~-L.~~L•1ft1'HER CERTIFY that 1 will register at my local address when the registration books reopen, and ~
j comply with a!1 other requiremcnts of a
lega~l~re_sident of this State. ' ~~~s~
~ O~~i?~~l ~ ~~0~rt- /~1-+a~e .
~ I FURTHER CERTIFY that I have no intention to return #o my former domicile~ and I intend to remam in j
_ ~
s Ft. Pierce _ , St. Lucie , County, '
F Florida, permanently. -
! ~
~ Witness;
(Name)
Be o in
f
~ (Addtess)
~ Sworn to and subscribed before me this '~1 day of
! `
; ~ A. D. 19 7 3. ~
; ~tilc.L.C.- ~ ~
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Notary Public St f Elorida at Large i
' h1y Commission expires ~ ~ y ~ ~ -
i
E (To be esecuted in duplicate and origina! filed with Clerk Circuit Court, and duplicate Nith Tax Assessor)
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