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Declaration of Domicile and CitizeftstVij) tOUNit~ ru.
TO THE STATE AND COUNTY TAX ASSE380R,
St. Lucie
COUNTY, FLORIDA:
'Thia :.a my declaration of DoUlicile and Cithenahip in the State of Florida that 1 am filing ~his day in
accordance, and in conformity with Chapter 222, Section 2~Z.1'i', Florida Statutes.
I was formerly a lei'al resi~ent. of.nm___'__~~~_~!c_!~_n_'__nh_mon__u_____n___mm_.' _n__~_~~_.J~_r~mmn__non___
(City) , (State)
and I reaided aL,g69____4~ndu::>.~.r_~,~_~___...____m_um'___'. , ,_____0 However, I have changed-my domicile
(Street ILDd N \W1ber) -
to and am and _ ve been a bona fide resident of the State of Florida since._, 1 -- --, ._m.._ day of
_m_____m~_~_t:!~~_~r_.nm_m.,_______' 19uQ9_. and I reside at_u___J~~Q_j1f3_~ t_n1-J!_K.ILJ,;lrjy~__ ..__u_nn_onnmm____
(Street ,nd Number)
'n __.,____~_~~_~__~_~~_!'.~~__n___ ____,____ ___n.___.,.' ___n_'_r_.n. __, _~~!____~_~ ~J_~__non__m'_:______,___, County. Florida.
(City)
and this statement is to be taken as my declaration of citizenship, actual legal rElsidence and domicile in
the State of Florida.
(lnaert here any pertinent facta, aueh c.a ..le of property or buaineu, or re.1inquiahmentof emplQym~t at
former comleUe. removal of family to ne. domieile. purehue 01 home, etc.) ... -
Applying for homestead
Merchant sailor ar.~, has not been in the stute for t Qis past year.
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I FURTHER CERTIFY that I will :reaistel .t my local addre8a when the repuation boob reopen,
and comply with all other requirements of a legal resident ot this State.
I FURTHER CERTU"Y that I have no intention to return U> lAY former domicile, and I intend to remain
. Fort Pierce St. Lucie
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( Cft7)
permanently. ___n_~~ (~~ ~_~______-
Sworn to snd. luOacribed before ma tl1ia__~_uday of
. March
Harry H. Kagan
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61
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, A. D. 19__.
Clerk of Circuit Court
Roger Poitras,
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(To be n~tod In duplieat. aDd or~ fiW witJl an Clrcu..4t Cont. uc! chr.Weste ..nth Tu Aaaw:lOr)
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