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Rob ertj,.~udph~Y 3~)fl
BOOK t JJ
Declorotion of Domicile and Citizenship ST , l1CIE CruNTr. FLA.
TO THE STATE ANll COUNTY TA.X ASSESSOR,
~+ f~IGS.~ 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 _-_ WALTfiAT+K _ _ . _D~SSACHU~I~TTS_ .-._..
(City) (Slats)
and I trsided at i1SS weif-' _ St =- - - -- -- - Iiuwevec. I have clliulgrti my 3v,-.icile
(Street and lv umber j
to wntl am a^d' hwe lwen a bona fide resident of the State of Florida since 17th day of
January 19 ~1 ..... , . _ ,... _. - __- ~~ O~aac ;,'1.:e Qoe _.
_ -_ , and 1 reside at . ~uiiu _-tt_ ~~?1_n~c~-11..x. _ _ -
(Street and Numtxr)Meil~n$ address
FortPi erc e ~ St .Lucie __- .----County, Florida,
(City )
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
former tom cile? remro alnof family to new domicile~pnrchase of home. e~r;ltnquiahment of employment st
Mr. andMrs.HampJ~~t>ot:s Humphryy areliving in SeminolePark Subdivision
and willenter three children in public school.
1- Robert A.gumphrey
~_ t[sannAth T.ee Humphrey
.. m: - - ~-.-. v..l p LT~~rnnhrAv
J- 11HaV VLJ uj +- i-•+--r' - -+
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._/mot. ~dtSal
FILED,At~D RECORDED
IN . -- !~'u~-t''~ l
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....
I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
~n.~ ,.,,,,,.,ty ..•;th all nthPr re~uirPments of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
Fort Pierce St . Lucie -County, Florida,
(City) "
permanently. , ~~~. ~`' -~.- - -
( e) ----
Robert E.Humphrey
---- --- -------------- -------------- ---------------------- ----------------------
(Addreaa )
....~..,
Sworn to and subscribed befat+a ~~; t,}-is_ - 2~ -. day of
,,
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Q/1 ~~?_~_ -_ - ~ I --
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-- -- ---- otary Publi¢ ~Stata a ~t~ l~a
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My Commission expires:,,: ~ ~~~~"~- - -------------
_ .:.,
(To be executed in dtiplieaW 'ind original Sled with Clerk Cireuit Court, sad duplicate with Taz Assessor)
~tnw••n Buoolr l'o.. Phut Cit 7. Fln.