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;' •~rlr ~~11NTY, ALA.
Declorotion of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
St . Luc i 9 _COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.1?, Florida Statutes.
I was formerly a legal resident of___-- - NenOrleens ----------- - - ------ ---- .- . --------LQilifll.BMa-- -___--
(Cit;) {Slats)
and i resicien ai i~v(% ~, A-~-!JiiVS±~- Y - __--_. ~ ` ' - -'
--_- However, I nave cnangeti my UUIU1C1lC
(Street sad Number)
to and am and have been a bona fide resident of the State of Florida since 15 day of
ug -
A ust_ - _ .. _- -_ 19___-__60and I reside at _-1008 S. 7th5treet
Fo rt Pi ere e r St • . (street and Number)
Lucie- -- -------- --- - ---- ---- County, Florida,
(City)
and this statement is to be takers as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(lnaert here any pertinent facts, such as sale of properly or business, or relinquiebment of employment at
former domicile, removal of family to new domicile. pnrchaae of home, etc.)
Applying for homestead
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i 1~•ii12`li-1N:!{ I:M:1('!'1FY Thai; I will TP.i_f18teT al: mV loCiil 8ddress vYllCll the iei(iStiutivi, vviks reopen,
aru; con~,l kith all other requirements of a iegai resident of this State.
I I•'URTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in-____-_----Fort Pierce - -- _--- - -_-_--, St. Lucie _ _County, Florida,
(City) ,, ,
permanently.
----- - -------- - - -
. -- (Name)
. (Add3~lsrs~ .
Sworn to and subscribed before me this ----20- day of ~~ ~ ~* .b
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---~a-l~ua ry A. D. 19---61 , C ' , ~'
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Ro er Poitras Clerk of Cireuit__Court ~ ••' ,-. ~' •
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(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Taz Assessor)
r. .... .. a., ,: t:i. ~ ~. 1'!-,, ~ r~rr. Fin.
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