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254983
Deciaration of Domicile and Citiienship
TO THE STATE AND COUNTY TAX ASSESSOR,
St . Luc ie CpUNTY, 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.
. I was formerly a legal resident of a8our8 ~1 ~
, and I .
303S9 Mulholland Hwy. ~~t'~ ~s"``~
resided at ~ . However, I have changed my domicile to
(Stteet and Number) _
and am and have been a bona fide resident of the State of Florida since 1st day of
April 73 2301 ~ak Drive
, 19_____, and I reside at
(Street and Numbet)
Fort Pierce St. Lucie County, Florida,
(citr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insett Aete any pertinent futs, such u sale ot prope~ty or business, or reiinquishment o[ employment at former
domie~e. remova! of fsmily to new domicJe, pwchsse of home, ete.)
Entering children in school :
I have custody of Jennie Phill~ps, my neice, who will be
living with me permenantly. . .
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254983
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legai resident of this State. _
i I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
~ Fort Pierce St . Lucie County, `
! Florida, permanently. cc~~» . '
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~ ;~vrr~, ,and b~d~before me this day of
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Sr A.D. 19
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ROGER POI~fRAS, CIERK CI CUIT C URT
B D ~ BQQx 214 PA~r ~~.40
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