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DilClaration of Domicile and Citizensh'~i . 5 3:}1
l)). LUCIE COUNTY, HA.
TO THE STATE AND COUNTY TAX ASSESSOR.
St. Lucie COUNTY, FLORIDA:
Thia ia my declaration ofO<.mieiltl and CitiJ.enahip in th" State of Florida that I em dling this day in
'\ccordance, and in conformity with Cha~ter ~22, Section 222.17. Florida St&tutes.
I waa fonnerly a l('pl resident oL------Washingt.onh______hhm_h__________________, ____m__________D.c...Uh__U_____
(Cit)') (State)
and I reeided at __ 1512___.30thuStr.eet..-.N..Yii~--..- _____m___.____.___. However, I have changed my domicile
(StrMt -'Dei Number)
to and am and have been a b~na fide resident of the State of Florida since __._ nt-h__m____________ day of
___._h_March____u ___________m_________, 19_u6~, and I reside lithKem.l0.o.duRd..__Rt.__2__.B.QX__43_75__Lake~oQd Pk
(8~t and Number)
__ -----.F-ort--P.i-e r-c~-- ___ ________._______h____' ---3 a-1: a ~-&-----.----.--.- Uh______ --.-. 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.
(lnaert here any pertinent facts, IU..:h u ~le of prQpert)' or bulliness. O;)r :.llnquiahm.nt cf employment at
former domieilo, remonl at flUDil)' to new domicile. ~l1nhaH 01 )aome. ..~
e5tablishin~ residence
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I :F'URTHER CERTTFY that I will register at my local addre88 when the registration books reopen,
and comply with all other raQuirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicile. and! intend to remain
in._nm_f 9_:r_t; _ __~_~ ~_r_<;_~_ _______00___ ____ _ ____ _ ___mnu ---.------ ,
(Cit)')
pe f'rrI..anently .
__~_:t;._!.1y.~1 ~___mn..__n_____n_.._________h__ ..County. Florida.
\ ~ J, _ ~_. ~~_ ____nuu______._
_ .~u_ _ - 1-/A.--~.2;.. J~
, (Name)
Alf ed L$ Tennyson
_._. __________ __ ____ __ ___+__ ___~ - - - .______ __________~ - - _.__ ____ u________ __ '+
(Addre.. )
Swore to and 8ubseribed before me thia_?~~___.__day of
__~;=b~~~.~~.-19=~~
My Cvrnmission expiret___.J~~__J.J____J..2Q_~
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(To h. l!1.:ecuteJ in duplieate and orilrinal tiled with Cl.rk Cireuit &.Gft;'~cr~~~at.e with Tax AaMU<lr)
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