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~s~lar~tlon ot ~+~e~t~il+~ ~~r~ Clti~censlsip . ,
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TO THE STATE AND COUN~If TAX ASSESSOR, `
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ST. LUCIE CQUNTY, FIORIDA: ~
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This is my declaratton of Domicita and Citizen~hip tn the State of ~lorida that I am filing this day in acca~dante and .
in oonformity with Chapter 222, Section 222.17, Florida Statutes. ~
. caliir~s ahio
I was formerly a lega) re:ident of r-----~
~~ih,~ (State) _
and I resided et ~~~r Riv~= Rotd . However I have chan~ed my domicJle
(Straet and Num6e~) ~
~ t~ and am and have been a bona fide ~e:ident of tha State of Florida eince - day af ~
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~ NovCmber ~~q 64 and i rosl~fe at 3Y~ S° Market
{Street and Number)
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1'ORT MERCE, SAINT tUC1E C4UNTY, H.Oit1~A • • .
~ end tht: atatsment ie to be taken as my declarotion of citizenship, actuai legal ro:idence and domlcile in tfie State of Hortda.
{Insert hare any perti~ant facts, such aa sale of property or business, ar retinquithment of employment
at former domicile, rempval of family to nev~r damicNe, purchasa of home, etc.) .
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~ntering ~onaict Bo ~-in the ilth grade ~ F~~~~ QA~D RFCOR -
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Danny B ia ~he 9th grade ~~!'~~,~-'~OQK
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~ 5teve~ B ia the ?th grade ~48
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~ Deboxah $ in the 5th gr$d~ ~ euer~ couNrr. F~OR Da
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1 FURTHER CERTIF1f tfiat I wili aomply with all ottwt r~qutr~nts of a te~a) Pasidont of thl: Stata. .
1 FURTHER CFRTIFY that 1 have r~ intention to ratum to my fsrmar domic~le, and 1 intend to ~emain ln FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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; r.• ~ ~ '1 ~t ' (Name) - '
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. .C'~. ~ BCib A l+d1C1A3
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. S ~ t = ~ ~ r ' ' (Address) .
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, ~ J_ - ~ ~ 17th Nov. ~q 6'~
- St+~rorn t+o ~ ibsd befori me thf~ il~y of .
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ROQ~ER POiTR/!~
. - ; - ~iRCUiT COtB~T . ~ Notary Publk , . ~
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~y D.C. . My Commlulon expl~~ . _
~ : . ~ . ~ 03 Fac~ 232
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(To b. iaua~d in d~ea1~. s~et ori~iNal f~d w~It~ u.~k s~ Caart. ~wa ~p~at. ,~M T.oe A~....o~a
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