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s. H. Perkins
Declaration of Qomicile and CitizensW)
f:)
55/
TO THE STATE AND COUNTY TAX ASSESSOR,
St, Lucie
'0: T, l. UCIE C('llI~HT. rL A.
COUNTY, FLORIDA:
This is my declaration of Domicile and Citi7.e~hip in the State of Florida that I am tHine this day in
accordance, and in conformity with Chapter 222, Section 222,17, Florida Statutes.
,--
I was fonnerly a legal ~sider.t of ." 1.illcon..... '.._........'..m.'....'......._m.mm.' mGe.Or&is.L...,..............."
(City) (State)
. However, I have chan~ my domicile
and I resided lit 609 Cherry - ' , ....,........
(Street aDd Number)
to and am :md have been a bona fide resident of the State of l<'lorida since jz....... day of
!~Dvem ter .' , 19 56, and I reside tit .......).J9J.J1~yf.J.._C?.!'!e_~_IlQ~,~_ ".........,.....__._'...
(Street aDd Number)
.., .........._....._.."....., S,t,t, "L\l, C:UL....._~........_ .,.,......:.. .......... '.. ..County. Florida,
........Fort Pierce. ,__
(City)
and this statement is to b~ taken as m) declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(Insert here >>.ny pertinent fILet..;, luch u lale of properly or buaiLeas, or relinQuiahment of emplo)'mct at
former domicile. "moyal of family to new domicile. purchase of home, etc.)
!J3566
FJEC ,'.r:C r~~CC:\QEO
1~!~~c-.,.,{",4'~--<:O~l~ ~
I" .:;- ~;.)Il!! n' n'.
I I ~l ~J. I,-1'
, .
~ i, LUCI~ COj.'nr. fLLr,,,,i\
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 fonner domicile. and I intend to remain
permanently.
- - . ..- -~-- -- - ----- --..- ---.. -- .---..,
. (City)
"_U'"~'~'~h''~~~~'~'~''U''''' ,..,_ .....h...hUOU.. ..County. Florida.
"...~~?mn_n....._n...__..._.
in
fort :'ierce
'. .~.
0. H. Perkins
{Addrelll )
Sworn to :and imbscribed before me this 30. day of
.-.-..-:, :'~rch. ' '....'-./J...'. L D, 19,..61,
. '....... ;,' -::/. ? 1//" . / /c ~--:t:~//
.--..-... . -- ..... --- .-,. -/--. ..---.--...-,-<.. -......-.-.--.-
Notary Public Stayofporida at LU...
// 1.-/:...
My C~~miggion cxpire!l'... ,..,..61?JI9J.._...n._______
(To be executed in duplit'ate and oriJinal filed with Clerk Circuit Cllurt. aDd dupli~ate with Tax Asseslor)
HO\Ao"pn ~noDlv Coo. Plant ('it Y. ..'1n.