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_ Dectaration of Domicite and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, . 2~4
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ST. LUCIE COUNTY, FLORIDA: ~
This is my dcclaraiion of Domicile and Citizcnship in thc Statc of Florida that I am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes. '
I was Cormerly a legai resident of Gambr i 11' s Mary land
, and I
`-'F: 0. Box 301 Claf fy Ros~'`'') (~''c`)
resided at , However, I have changed my domicile to
(Street and Numbe~)
and am and have been a bona fide resident of the State of Florida since 12 day of
September 19~ and I reside at 4IS Iiernando Street~ - Apt . 2
reet artd Numbet)
Palm Haven Apts. Fort Pierce, St. Lucie County, ~a. County,Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert hete any perfine~t facts, suth u sale of property or business, or reli~quishment ot employment at totmer ~
domic~e, remoral ot family to ~ew domicile, purchase ot home, etc.) •
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ENTERING CHILDREN IN SCHOOL: n HOMESTEAD EXEMPTION: r~
If entering chiidren in school., ~
please iist their names:
Tina Marie Fink
T~mmy Ann Fink
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3~.LUCiG .::t~~RAS~ , ~
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' CIfRA G^ :~l1 CdUitT t
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F~ ~ ~ 9 14 ~'7~
2'743'7 3
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I FURTHER CERTIFY that I will register at my tocal address when th~ registration books reopen, and
comply with all other reqairements ~f a legal resident of this State. -
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
Fort Pierce ST. LUCIE County,
Florida, permanently. «'~y~ y • ~ `
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.~~`Ltt c;~ : Thomas J Fin ~
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Sv+ror~p~ ~'o ~d: sul~,sc$bad ~e~'ore me this day of
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i : - - 415 He rnand o S t . ~ ry
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f . . ' ~v ; A. D. 19~. ~ ~
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~ Ft . Pierce, FZa. Florida ~
ROG~ ,'PO~~S;~~CLER IRS_l7T CQUg~ ~ ~
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BY c Deputy Clerk ~
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(To be e uted in duplicale and original filed wilh Clerk Circuit Court, and duplicate with Tax Assessor)
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~~~x 223 ~A~~21~80
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