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BOOK
Declaration of Domicile and _Citizenship s;: ~uciE c~~~NTr, f~A.
TO THE STATE AND COUNTY TAX ASSESSOR,
;,, int Lucie
COUNTY. FLORIDA
T'hia is my declaration of Domicile and Citizenship in the State o~ Florida that I am Sling this day in
accordance, and in conformity with Chapter 222, Section 22$.1?, Florida Statutes.
I was formerly a legal renidAat of--__--- (lr+inhn .""' _,`"''~
• (City) (State)
and I resided at -_- 30~~ $ - ht3th-__; LTeeL - However, I have changed my domicile
~~ireet sari Numwrl
to and am and have been a bona Sde• resident of the State of Florida -since the 30th. _-__-day of
----------._DecQmbel'_-_~.9E~~?-__.-__--, 19__60, and I reside at------------~.~f~---~.--Sito-_~Otu't~__--__-___.___-- _ -- -
----
Port gteLuci (street and Number)
---- ------Ford--Percg-~~a.-------------------------, -------------- -- 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.
(Insert here any pertinent facts, such as sale o1 ropertyy or business. or relinquishment of employment at
former domicile. removal 01 family to new' domicile, purchase o! home. ets.)
Formerly Accountant in office of Vice Pres. & General Auditors
Union Pacific Railroad~Omaha Nebraska.
Attained age of 65 on Decem~ier 111960 and have 1~ relinquished
all rights to return to such employment and hav~to the Railroad
Retirement Board for annuity. cy[~-~
New residence at Port St.Lucie was completed on Dec,1~~1960.
Residence at Omaha~Nebr.has been listed with Realestate
Company fog sale~and it is intended that Florida be our legal
residence henceforth.
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I FURTHER CERTIFY that I Hill register at my local address when the registration books reopen,
anil t•mm~ly with all other requirements of a legal resident of this State.
I FURTHER RTIFY that I have no intention to urn to former domicile, and I intend to remain
z
in----~N ----------- - ---------- --- --- --------- - -----= - -'~=~_-~~'--------- ----- --------------County, Florida,
- - ----------(City)
permanently. ~ -- --------------- --- --- ----- -
(Name)
---- -- ---------------~----I -•-- ------ -
(AddrlKtl)..,
.-
Sworn to and subscribed before me thi~-_~-.day of - - •••• •, ~ -
- •.
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(To be a:ecutod in duplicate and original Sled with Clerk Circuit Court, sad duplicate with Taz Assessor)
Kowvn liuDDtY t'o.. Plent ('Its, Rte.