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I?eclaration of Domicile azt~ C~1hzellahlp
ST, LI,~CIE C~UNT1'. ELA.
TO THE STATE AND COUNTY TAX ASSESSOR, .
3T. LUCIE COUNTY, B'LURIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing thL day in accordance
and in conformity with Chapter 722, Section 271.17, Florida Statutes.
I was formerly a legal resident of Luke Cha rle t
[City]
Louisianna
State
and I realded at - - ~ However, I have changed my domicile
(Street and Number]
to and am and have bean a bona fide resident of 4he State of Florida since 1?th day of
October is 82 and I reside at 718 Citrus Ave.
[Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA.
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
[Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile purchase of home, etc•]
Establishing reiidanay
t~.0~~3 ~, „..
ND RECORDED ' '
-
FILED A ~
,
, ,
-, .
1962 DEC °3 PM 2: 3~ =~ `~~ '~~,~~
j` - .
ROGER P017RAS, CIERK
~ ~.
, ~~ ••:: ~rnn; .•~,~ .
~ `~
-
S1. LtlCIE COUNT`f, FIORID
~ -~ ins' °~
.,,: _
~
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 FURTHEIc CERTIFY that I have no intention to retwn to my former domicile, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently ~ ~ j
~ ~ r
~~
Floyd R, Rigby e]
[Add.ress]
Sworn to and subscribed before me this Ord ~Y o~ ____ Daaember 19 62
ROC CLF.RKRCIRCU COURT `` ~ ~,,.-t`i i ,';;• .'rl' ---- Notary Public
ll }~ i _~;-.: Vii! .:. \; f~ _ . / ?l c
3 ~ ' ~,~; My Commission expire.
:~.~5.. ter,',
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[To be execute] !tt dagllcate and orldinsI fi3y3~br~tt•Olet~~*pdit apart, snd duplicate with Tax Assessor]
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