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D~~larati~n et ~ornicile and Citizens~tip
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TO TNE STATE AND COUNTY TAX ASSESSOR,
Sj. LUCIE COUNTY, FLCRIDA:
This is my declaration of ~ornicile and Ci!izenship in the State of Florida that I am filing this day in accordance and
in conformity with Ctiapter 222, Settion 222.17, Florida 5tatutes.
Ir~diana
I was formerly a legal resident of _ _-ar-~ . - -
(City) (State)
and I resided at _ 1d23 N CaSSC1U3 _ Ho~vever I have changsci my domiCile
- - -
(Street and Number)
to and am and have beer. a bona fide resident of the Siate of Florida since _20 day of ~
August 6S 8S b32 S 12th Street
- - - 19---, and I reside at
(Street and Number)
F4RT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
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and this statement ~s to be taken as my declaration of citizenship, actual legal residen~e and domicile in ihe State of Florida, i
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(fnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former dornicile, removal of family to new domicile, purchase of home, etc.) ~
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Bstablishing r~sidence ~ ~
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} I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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} I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
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PIERCE, SAINT LUGE COUNTY, FLORIDA, permanently.
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, _ • _ (Name)
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:ti~`.~ • ~ ' ' Lawrence Whisler
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.:'r.'i:;~ (Address)
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Sworn to and subscribed before me this - 4" day of - abuary ~ 19 66
ROGER POiTRAS
CLERK CI IT COU T Notary Public
gy ~ D.C. My Commission expires
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(To be executed in duplicate and original filsd with Clerk Circvit Court, and duplicate with Tax Asaess~or.)
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