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Declarat~on of Domic~le and Citizensh~p ;
~~v~46
TO THE STATE ANU COUNTY TAX ASSESSOR,
St. Luaie '
_ COUNTY, FLORIUA:
Tl~is is my declaratian of
Domicile and Citizenship in d~e State of Florida that 1 am tiling this day in ;
accordancc, and in conformity with Section 222.17, Florida Statutes.
1 was formeriy a Icgal resident of T~~~s _ ,_~~v? and I
(City) (Stale)
msided at ___~1 F~rotts Hi$m!_~1!_____ However, I have changed my domicile to ;
(Street and Number) ~
and am and have bt:en a bona fide nsident of the Sta e of Florida since 6tb day ot'
Lot ~ Hlook 2713 (Florida) ;
Fe 16 S e Laris (Military) !
~'~'7 , 19---?5. and 1 reside at 5
Port St. I.uais, Florids $t. j~yai~ (S~reet and Number) ~
3tarkville. MiBSiasippi _ _ Oktlbb~ha County, Florida, ~
(c~~y? ~
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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(Inuri here any prrlinent fects, such as sale of property or business, or rrlinyuishment of employment at former ~
domicile, removai o( family to ne~r dumicile, purchasr ot home, ~tc J ~
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t I FURTHER CERTIFY thai 1 will rcgister ~it my loral address when the registration books reopen, and
~ comply with all other requirements of a ic~al resident ot this State. ;
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; I FURTHER CERTIFY that 1 ha~~e no inteE~tion to return to my forn~er domicile, and I intend to remain in
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~ Prt St. Laaie__ _ St. Lwcie County, `
~ Fforida, permanently.
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- (Name)
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Sworn tcs~andsu,bscribed~,~fefure me thi~ _r__ day of ~
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My c4rr(tqi~~on . ~ - ~
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jJ.'. ~'o be raecuted in duplica~e anA unginal filed with ('Irrk Circuit Coutt. and duplicatr with Tax Assrssot) }
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