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Deciaration of Domicile and Citizenship
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'I'O THE STATE AND COUNTY TAX ASSESSOR, ~
S_~,__~•_U~ COUNTY, FLORIDA:
This is my declaration of
Domicile and Citizenship in the State of Florida that [ am filing this day in
accordance, and in coni'ormity with Section 222.17, Florida Statutes. -
1 was i'ormerly a legal resident of ~G~ES~ILLS ,~'ta~nY xT~? and 1
(City) (State)
n;sided at Route ~2 WeBCOeavill~ . However, 1 have changed my domicile to
(Street and Number)
and am and have bcen a bona fide resident of the State of Florida since ~s day of
MAY , 19__~3-., and I reside at Ia~ 19., Bic~t '?EiF~4 Pflrt St T,,tcie
(Street and Number)
PORT ST LUCIE , ST LUCIE County, Florida,
(c;tr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. .
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(I~sert hcre any pertinent facts, such u sale of prupertY ~ business, or telinquishment of employment at tormer #
domicile, removal oi family to new domiciie, purchase ot home, etc.)
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I AM A N~lBEER OF THE US ARMY AND HAYE PURCHASED T~ ABOYS MENTIONED LOT !
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WITfi THE IIiTE~iT OF RF.SIDIT3G IN THAT LOCATIOI~ UPOft MY RErIRII~tENT FROM TAE l?~RMY. `
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PLEASE MAIL ALL CORRESPONDANCE TO MY PARF~`7'i'S AT : ~
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BOX SS1, ROUTE ~2 ~ i
wESCOESVrz~, ~x~s~LV~ i81o6
zsQSSS ~ ~
Sr
LUC
~ COUNTY ftA.
ROC£±: Pp1tRAS
~«~x ~ 'CUIT COURT
pECCFr~ ~Fr.rF~E~.,~,,,,_.,.,~
~ 1 ~ 13 PM'13
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E I FURTHER CERTIFY that I witl register at my local address when the re~stration books reopen, and
i comply with all other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain in
E
~ PORT S~ LUCIE _ ST LUCIE , County,
Florida, permanently. u n ~~tr
~ po r?~ r~tirement from the US ArnXy.
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' ~X 551, Rt ~2 (Addreu) `
` Wescoesville PA 18106 #
~ Sworn to and subscribed before me this ~2Q___- day of
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€ N ~ _ A.D. 19~3__~~,~~5 - ~4-,:t.l'. ~
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5 r t - ` / ry ~ _ • ~
" ~ !'1U~ 4i'~tVU"D~~c~~{ j oi Florida atrLaree ` ~ ' 's ~_.`r. i:~ `s --i fC~ , i y
AGC,1.: ~
~ Ny Commission expires ~
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(To be executed io duplicate and origina) fded wilh Clerk Circuit Court, and duplicate with Tax Asussor)
s~217 ~ .
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