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Declaration of Domicile and\CltUelnlrip ru,.
TO THE STA'l'E AND COUNTY TAX ASSESSOR,
St. Lucie COUNTY, FLOlUDA:
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This i.e my deeiaration of Domicile and Ci~n.l:!ip in Ule State of Florida that I am tilinl' this day in
accordance, aild in conformity with Chaptn 222, Seetbn 222.17, Flodda Statutes.
I was formerly a lealal resident of,_u_uh_.uLQng__ls1S1.fHL__u.u__.____m__.m____. ___u~,~~.ur_QK~.. __......____
(City) ,State)
and I rt'.aidcd aL,., Spring,Str.eet.___.uu.,.._u__m.,_____u____, .___, However, I have changed my domicile
(Street &lid Number)
to and am and have been a bona fide resident of the State vf Florida since ,... 28th__,..,.,.______, day of
h?_~~.~~~,~~________u ______'____m_'.___', 19,6Q_, and I reside aLu.-.70l-.A.za~~~t:v~N_;;;;~;) _._'umh____u._____,...
f9, !:.~u~~_~_~~.~_" ____,____.,_'U'_h_______________h__U' -- ____.___m__ ____mm~..~_~_~~.~__~.:,____ '_h. ,County, Florida,
(City)
and this statement is to be taken a8 my declal'8tion of citizel18hip, actual legal retlidence and domicile in
the State of Florida.
(llUlert her.. any pertinent facta. IUch u uJ. of properly or bu.ai.nu.. or rellnquiahm~nt of employment at "-
former domicile. removal of f...uIy to new domicile. purchu. of home. ..) "
EstablishinG residence
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93084
flLE~ MW RECORDED
In$<:_~-~~.~BOOK
I~S: ;'iAR 13 ll:l /0: 18
~OGER POITRAS. CLERK
S;,lUC'r n!~UI:iy. r~Ot-,IUA
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I FURTHER CERTIFY that I will register at my local address when the regigtration books reopen,
and comply with all other requirements of a legal I'$ident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
__m_mnu_u___;?_~~.~!_?_.~~_~_ u .mh___U____ __, .' County, Florida.
_m ~~.d_.__r7__8Jd_u______.__.m_,_um,______h_
(NAtM)
Fred T. Ebel
in.___. _._ ____ 'u, u_u._. __F.o r .t...P.i e r~. em___.__m, _mu ,_... _.un_,
( City)
pennanently,
(Addn- a)
Sworn to and suoaeribed before me this__.___J),day of.
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... Co .. . J' c:. '961, ' ') - ., ,,'
UJ.y Il1!Jl1a81'ln exp~ --, u__ .an---.-.7") __ ... _ ~ . ,>-.,.. ".{ <. .,..'
(To be uecuted in duplicate and oririnal filed with Clerk Circuit ~~,~~~~(~~~ with T~)C Aueuor)
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Notary Public Statll of Florid4 at ~
Rm""" hDPly Co., Plant City, Fl.,