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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNIY, FLURIDA:
This is my declaration of Qomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity ~vith Chapter 222, Section 222.17, Florida Statutes.
Parkersburg West Virginia
I .vas fnrmPrlv ~ IPnal resident c~f - - - -
. y (City) (State)
and I resided at Rt_~ _ . However I havechanged my domiSile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ..15$h day of
September ,o bS v~a ~ roj;~o ~f 1200 Ormond Ave.
. _ . - - - . : : - _ .
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this st3tement 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 emptoyment ~
at forrner domicile, removal of family to new domicile, purchase of home, etc.)
New Domicile
, ~ - ` '`.~'_Ufil Iii1D RE~ORDE`D
R~c~td_ ~ o o K
~ . ~ °66 J~~N ~ . '
_ Iy Pt~ 1,56
_ . - ~ - - - 1-4..`z0O~
.t ' ~ ~ - ~ ' ROGcIt f'::, !'ri:;j. C`~RK }
i:~''-; Si". LUCIE C~l1N i Y,
. . f LOFtIDA
. . i
I FURTHER CERTIFY that 1 will comply with al) other requirements of a legal resident of this State.
{ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
i .
~ ~ Russell E. Weekly
i , ; ' . _ . (Name) -
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~ ' ' ~ ~ 14th Qanuary 19 66
# Swor~ to and subscribed before me this day of _ , •
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public .
ay ~J'~'P.9' D.C. My Commission expires
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(To be executcd in duplicate and originat filed with Cierk Circuit Court, and duplicate with Tax Assessor.)
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