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D~+cl~rati~r~ o! D~mi~~~g at~c~ Citi~~n~h~~
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TO THE STATE AND COUNTY TAX A5SE5SOR,
Sl. LUCIE COUNTY, FLORIDA: i_~~~C~~~ ~
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing tNiis day in accordance and +
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in conformity wiih Chapter 222, Section 222.17, Florida Statutes. f
I was Formerly a legal resident of . _ _ . __~a?'1t011____ _ . ~jg~_H~pg~~___~_ '
~ (City) (State) j
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65 S~hool street s
and I resided at _ _ - _ _ - _ _ . However I have changed my domi4ile ;
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since __~'S day of
JaritiaT~T , 19 66___, and I reside at ----1212 DB~rDt3ri AV@riU8 i
(Street and Numher) {
FORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA ~
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and this statement is to be taken as my detlaration of citizenship, actual legal residence and ciomiciie in the Siate of Ftorida. ;
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
aT 7U~IIiC~ (,iui~iitllQ, removal Of ioii~iiy ~v `~^^?;t:~O, ~!!(C~'!a5? of home, efC.~ ~
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~nter~ing ahildren 3n elementarp school
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I FURTHER CERTIFY that I will comply with all other requirements of a Iegal resident of fhis State. i
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I FURTHER CERT)FY that 1 have no intention to return to my former dorni~ile, and I intend to rema.in in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORtDA, permanently. ~ ~
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: ~ ~ . ~ r ~ (Name) 3
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' " ~ . ~ Yvone Guimond ~
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Sworn to and subscribed before me this ~7 day of - J~~~ , 19~ .
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ROGElt POITRAS
CLERK CI UIT COURT Notary Public ~
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BY _ D.C. My Commission expires ;
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(Ta ba executed in duplicate and original filed with Cle?k Circuit Court, and dupliwte with Tax Assessor.) 't
BOOK ~.~s 3~9 - ~
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