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~ecl~rati~n ~t D~?r~i~ile a~~d Citlzenship ~
TO THE STATE AND COUNTY TAX A5SESSOR, '~~~-~,~+`~f}
Sl. IUCIE COUNTY, FIdRIDA:
This is my declaration of Domicile and Citizenst~ip in the State of Florida that I am fi~ing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statuies.
I was formerly a legal resident of . ~~i8D~nti~ _ _ _ __A _C~g~t; a~_.
(City) (State)
and I resided at - - -
~19 P&lley S`t2`est . However 1 have changed my domi~ite
(Street and Number}
to and am and have been a bona fide resident af the State of Floricla since 2s
_ - day of
--eT8t1Li~2`~t' 19__~1'~, and 1 reside at ----------1tQQ_~rs~3g--~3- t-~r_I,Lt6~.A--
(Street and Number)
FO1tT PlERCE, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, ourctiase of home, etc.}
~~,F?~-~AMp ~~C~ p
. _lC~Bf ~~L't) EU .
~oK
'66 JAN y ~y !~u-~,~ '
I I : 04
~ . Roctr~ t-~~,,~4~F~`~~
~ . . ~ S i. LUC1~ COUNTYRK .
= - F~i~:ablishing pe8idence F~.ORlQq .
- - _
. _ .
, -
• . - ~ ,
.
I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
,
I FURTNER CERTIFY that ! have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~ ~ v~
~~-r.~~--
~ . ~,/~a.,~-r.c. t, ti~(~,k-~-t.-c.-t~
;.•:'`..~,"i..: ,
; ~ , " (Name)
'..i ~ ,,v f '
• ' . ' t,
. - , ' ~ : ~ - MyY°on A. & ~aria Marenin
~ •
- ~ - (Address)
' , --1~, ~ ` '
' ` , :
~ . 4 a
r ,',~~S,itiOiG'i:to ar~d:subscribed before me fhis day of }q ~
. ' ' '
ROGER POITRAS
ClERK CI IT COURT Notary Public
BY - ' D.C. My Commission expires
(To bs executed in duplicata and original filed with C1erlr.Circuit Court, and duplicate with T:x A~aeasor.)
QooK ~.35 - 35,2 ~