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O~claralion ef ~3art~icile and ~itizenship ~
~
TO TNE STATE AND COUNTY TAX ASSESSOR, i~~~~v~
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and #
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in conformity with Chapter 222, Section 222.17, Florida Statutes.
2 ~
i~vas formerly a legal resicie~~t of C~.@V~918tt11(~- 3- O11~0 ~
(City) ~State) ~
,
101 E 211
and I resided at . However I have changed my domiGile
(Street and Number) '
. '
to and am and have been a bona fide resident of the State of Florida since day of ~
October 65 613 Bgach Avenne River Park ~
19-__-, and i reside at ~
^ (Street and t~lumber)
FORT PIEaCE, SAINT LUCIE COUNTY, FLORIGA
and this statement is to be taken as my deciaration of citizenst~ip, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facis, such as sale of property or business, or r~linquishment of employment
at former domicile, removal of family to new d~micile, purchase of home, etc.)
~tablishing residence i
~iL<~,AN~r ec I
! ~+t~tl~l B o ,
~
'66 JA(~ 7 kM I: 5 8 ~
~
-~-~,1buE„• ~
ROyE~: i-~f-i fl.`,S. CLEi~~( ~ 3
. -ST. LUCIt COUtJTY. ~
~ ~ - - • FLORIDA
.
_ ~ ~ . ~
- _ ,i ~ .
''~•l:~F.URTH~R CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY ihat I have no intention to return to my former domiSile, and I intend to remain in FOItT
PIERCE, SAIN'[ LU~IE GOUNTY, FLORIDA, permanently. ~
s ~ t - - • r-----~
. t ~a
, ~ a ,
. = Mary E. Winter ' ~~f -
~ ~i (Name) .
~ =,t - J;
. . - . . i Ge01'ge D. ~int.9r
~ ~ . ~ ° ~
- • ' ~r; ~ (Address) -
; ~ .
Sworn to and subscribed before me this 7 ciay of a~~~ , 19
ROGER P6ITRAS
~ CLERK C UIT COURT Notary Public
gy . D.C. My Commission expires ~
(To ba exscuted in duplicato and original filetl with Cterk Circuit Court, and duplicata with Tax Assessor.)
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