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Declarati~ .(i'I~,.ilIl.Aand Citizenship
. __ ...~_-.A..
TO THE STATE AND COUNTY TAX ASSESSOR,
_.-St... Lucian_____COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accord.nce,
and in conformity with Chapter 222, Section 222.17, Florida St.tu....
I was fornWrly a legal resident of
New Yo:rk
New Y_ork
CSt-)
(City)
and I resided at
9147,GGth Row
(StrMt end Numbet)
How.~..r, I have changed my domicile
to and am and have been a bona fide resident of thtt State of Florida since
16th
day of
July
, 19 61 , and I reside lit
520), San_Diego Avenue -
CSt,..t end Nvrnber)
,Fort Pierce
S_t. ,Luciep
County, Florida,
(City)
and this statement is to be taken a, my dec!ar.tion of citizenship, actual legal residence and domicile in the State
of Fk>rida. .
(INert ... eny pertv.w 'em. IUCh .. .... of pIoperty 01 bwlNu, 01 r.llnqullhmem of employment .. tom- domicile.
...-e1 ... 'emIIy to ... doMIdle. ~ of IaN, *-)
Moving into new home
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96754
FILED AND RECORDED
IN {lfiu.,1 ~ ~'r!80JK
196! JUl 24 Pf' I:,S
R .. ... - ~o 'Tr. .,. ~I r~v
\vVi-h I I .~..., "L '
Sl.lUCIE COUNTY. flOi\luA
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I RJRTHER CERTIfY ttMt , will register at my local eddr... when the registration books reopen, and comply with
all other requirements of a legal resident of this State,
I RJRTHER CERTIfY ttMt I have no Intention to return to my former domidle, and I intend to remain In______.
______n_.:.~::__'.....For-t-.P1erc8-----n----' _ ---_ __,____nS..te_Luc.1e. ,-- -- - County, Florida,
pernaenerJlly.,,'''-':: (CItyt /)~ A d~ ~
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. .,~:' v\ "..,.~ 0 (,..;:,..:' . A a Hall J aMson
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r '~ ~ .:..=. ",:., - j,\' ',/: ~, l. 520) San Diego A venue
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"'~ :......, :.:~~: I'.: ~. __.For.t._P.1.er.ee:t_..lloridan_________
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,\ ....~~,~~.beforemethil Of.L----- day of _______ ____ __n_nn____n__,19JQJ_
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Iv -':tYJ.~-~----------- D.C. My Commlulon oxp/'" _______u_u___u_u_u__u
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