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~T. LllC!E COUNTl, q,A
Declo!ation of Dori,icile a~d Citixel'iship
TO THE STATE AND COUN'I'Y TAX ASS~R.
St.L\\c1e COUNTY, FLORIDA:
Thia is my d~laration of Domicile And Citizenship in the State of :(l'oridaUlat I am filing this clay ill
accordance, and in C('l)1Jormity with Chaptu 222, ~tion 222.17, Florida Statutes,
1 W&.I formerly a lepl re8ident of..________'M,1,~y~J.J.~_.____________._..._..____.n_____.' mn__~_~~(.~__~.~!'~_~Y:____.___
(Cit.Y) (sWe)
ani I ~ided aL._____#54.__~~ngwOq-<!.-~,y.~~!1-~--.----..'.-.m.....------, However, I have changed my domicile
(Street aDd N UlAbex)
to and am and have been a bona fide re!'ldent of the State of Florida since ---.----])..- --. ----.---------- day of
____..______~~~h.._____.__m______' lS..s>J?. and I reside a L.__..._______.nl~_f.J1 g~.~~?_ !ld '_'n' .._._.___._ ___..h_._..'.
(Street and Nu::nbu)
___.F.or1i._p1~T..~~___.. _., __.._~___~t. _L~~l-_~______.___.__._.._._ .__.COunty, Florida,
(City )
and thi8 statement is to be taken as my declaration of citiz.enahip, actual l.~ga! TMidence 8.J,d domicile in
the State of F1orida. .
(lnMrt here any lKftment tad". lueh aa aale of pl'Qperty or buainea.. uf rellnquiahment 01 employm_t at
fOJ'IMf domldJe, l"i..."l'al of lam.lly to new don1ieU., purehaa. 01 helm.. etc.>
Applying forhomestead
9278';'
IN FlLfOc A~ID ~DED
f95~-._BOOK
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I FURTHER CERTIFY that I ~ll regiater at my local addreSlI when ~he reptr&tion books reopen,
and comply with all other requirementa of a lei81 1'OIident of thi8 State,
I FURTHER CER'I'IF Y ~t i have no intention to retQrn to my tanner dom.icll~, and I intend to remain
FortPierce St. Lucie
( ClQ')
_County, Florida,
in
Sworn tQ and .ubtcribed bdON.Q8 thia_L_.dI.J of
l-\arb}. 61
_ __ A. D. 19_-....
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