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O. R. 6 64J
Declaration of DomicHe and Citizenshi~nuK
- ~T, LUCIE COUNn. flA.
TO THE STATE AND COUNTY TAX ASSES&:OR.
S'(,.Lucie
COUN"r'Y. FLORIDA:
This is my dec1.P.ration of Domicile and Citizena~ip in the State of Fll)rida that I am tUin~ this day in
accordance, and in conformity with Chapter 222, Section 222,17, Florida Statutes,
I was formerly a legal resldent of _......,Winchest.er_..._.__.........._..,..._.._._.n.." mn_..m....._~_...__~~~_!:~~-~y
(City) . (State)
".' . However, I have changed my domicile
co
Florida since _",1st, .._"..,mn.. day of
,33.. Hampt.on..Ave,..........
(Street and Number)
to and am and have been a bona fide resident of the State of
and I resided r.t
. $ep~::~e~ier~~ un' 19{,(), and I ,...ide atunnn1901lnOh.=~Nt:,,;,rnnnn_n
_, ,.w'....' .._....__.....w......,-.___..._m_..-..' ._.._.......n n _.St..Lucien......._,_.._n.....nn .County, Florida,
(Cit~) ,
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida,
(Inllert here any pertinent facts, lIuch all lIale of property or businesll, or relinquishment of employmtlllt at
former domicile. remcval of family to neW domicile. purchase of hODW, etc.)
~s0a~li5hin~ residence and homestead
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S i, L U C lEe 0 U N H. FL 0 i\ Il; A
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in
,.....d F ort.Pierc.e.........w
(City)
Florida,
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..__~.......St.L ^ie..-.......,
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( N &me)
gh B Hammer,
p(>nnanently.
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(AddJ'ftll)
SW""l to and subscribed before me this..29.......day of
.. h 6'
_~.._..___.. . ......' l:'.?,~G... ........,_.__,......, A. D. 19___.."..
____....., a-~~d'ri!~-......._-_..._---
Ot.AT)' Pelblic State of Florida ai; La.re'
My Commission expi.-es..- ..........J,~,nm12~.__J9J?~__-
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(To be executl'd in duplicate and orieinal filed WIth Clerlr Circuit Court...nd duplicilte with Tu: Alaella<tr)
HlIW"" MIiDPly Co., Plant ClI1, FIR.