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Declorotion of Domicile and Citisenship~oo~ 4 231
TO THE STATE AND COUNTY TA8 A.gSES808. S1• LUCIE CQUNTI'. FIA.
3e int Lnoi a COUNTY FlARIDA: -
This is my declaration o! Domicile sad Clt3zenahip in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of____Chieego__ _________ -_ ________ Illilioia______-__.-
(City) (scat.)
and I resided at- 4929 - _ We8t____- 2~t~ _~g~t~e~__ - _ _-- However, I have changed my domicile
(Street asld Number) '
to and am and have been a bona fide resident of the State of Florida since _ 1St- - -- -_--_-.day of
October ~ 60 151 E1 Sito Court
--- -------- ----------- 19--------, and I reside at-------------------------------------------------- ------------- ------ --------
(8treet and Number)
Fort Pierce 3t .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 Y sale of ropertyy or business, or relinQuishment of employment st
former domicils, removal of famgy to new domicile. purchase of home. etc.)
Homesteading
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements 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.Luc ie ,
~---------------------------------------------------------------------- ------------. --------------------------- - -- - -- County Florida,
(City) L'
permanently. ~ •
v~; J eph P. IV~e e°~)t
--------------------------------------------------------------------------- --------------
- (Address)
Sworn to and subscribed before me this.-- 17 ---.day of =
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61 ~ •~'~
ebruary -, " '
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--- -`-------- ---- ---- ---- ~---------------------------------------- ~ i-
Notary Public State of FiorWa at Lar=e } ~• G 1 - :' ~_`.
My Commission expires__-_______--JeII 15~_ 1964 _ '~.~~;;• ..^..~~VL
c.' ~ z t
(To be executed in dnplip-te and original filed with Clerk Circuit Court, sad duplicate with Taz Assessor)
Hnwr. auoDh ('o.. Plant Cltr. PIS.