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D~~lar~t~on ~4 ~t~r~icit~e ~nd ~itizen~hiP ~
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TO TNC STATE AND COUNTY TAX ASSESSOR, .
S~ _ IUCIE COUNTY, FLORiDA: ;
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This is n~y declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accardance and
in conformity wifh Chapter 222, Section 222.i7, Florida Statutes. ~
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I was formerly a legal resident of M~_ Rt $nOla Penns 1V 1~ f~
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and I resided at _ _ . _ _ - . Nowever I have changed my domiCile j
(Street and Number) g
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ta and am and have been a•bona fide resident of the State of Flori~a since day af ~
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October 6 4705 Elm Aventae i
- 19--__ ~nd I reside ar - - F
(Street and Number) ,
FORT PIERCE, SAINT WGE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legai residence and domicile in ihe State of Fl~rida.
, (Insert here any pertinent facts, sucn ~s sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) i
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fistablishir~ residence ~
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ROG~~~: ;'G~ ? f::;~. C~CRK ' ~
~T. LUCIE COUNTY. . 3
F~ORlDA ~ ~ J~.;; .
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I FURTNER CER7IFY that 1 wi1! comply with all other requirements of a lega) resident of this State. ~
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• I FURTHER CERTIFY that I have no intention to return to my forrner domi~ile, and t intend to remain in FOR7 t
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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. / L~~-~}''4~ -C.-/L t r
~ . (Name1 %
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- Bertha Cre
sler Robert J. Cressler
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21 Februar ~
_ ~$+VCofc~•~o ~hd: subscribed before me this day of - Y , ~ q 66 .
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ROGER POITRAS
LERK CIRC COURT Notary Pubtic
By ` D.C. My Commission expires ~
(To be executed in duplicate and original fited wit~C,(er~~i~uifi Court and duplicate wit~ Tsx.Assessor.)
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