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Declaration of Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSf.;SSOR,
Saint Lucie'
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COUNTY. FLORIDA:
This is my dedaration of Domicile and Citizenahip in the State of Florida that I am filing this ciay in
accordance. &nd in COnfOlnlit)' with Chapter 222. Secti(jn....222,17. Florida Statutes,
I was formerly a legal resident of ____ _ --J ack.h~~ ______
(City)
__.___ ___ _______. _______K(';ntllS}:y
(St&te)
, However, I have changed my domicile
Post Office-
- ----+-------.- --- -.----.-_....__.
(Street IlJld Numher)
to and am and have been a bona fide resident of the State of Florida since 29th day of
-------- Juna.------------------------------. 19_6Q_, and I reside ut ___)459__~_o':-It:-_b___l~~r.9~__ H_~ [b':r~y _
(Street and Number)
.Eor.t__l'i er_c e _________.____________u_________________ _____, ._......u____. _ .____ ____________~_~_"_ 1. ~~i__~____.______ __ County. Florida.
(City)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile III
the State of Florida,
and I resided at _
(InS.,rt here Ally pertinent facl.li. .uch u .ale of property or buaineu, or relinquishment of employment at
former domidle. removal' of family to new domicile. purchase of home. .tc,)
,-
Entering Drema Lynn Hall in 1st ~raGe
Establishin~ home~teQd also
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I FURTHER CERTIFY that I will register at my local addre88 when the regi8tration books reopen,
and comply with 3JI other requirements of a legal reeldent of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in F ..ol:t_Ei!lr c e __._____________._____________, -..-~~-~~~~~~...m_..___m_.h_.h__m__ __County, Florida,
t1y (Cib') ~
perman~ . __'n' _ h, - _. -~-~:ui.m--___________.__m_
Herman Hall (Name)
-------~----_._----_._----------- --------------.-. -------------
8worn to and .ub8e:ribed before me :hiJ__.___2fLday of
( Addreu)
_~__M~rCh _______, A. D, 19.61...
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lf0tu'7 Pttl& 8t&t4 ~ J'Iorlda &\ x.,..
II)' Comm.lA1on ~ an 15, 1964
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(To be awut4d In dupUca~ &lid orilfnal ftled with Qerk CtreuJt ~-~ ~iieat..with Tax Aueuor)
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