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TO THE STAn; AND COUN'fV TAX AS5ESSOR,
ST, Ll;CIE COUNTY, FLORIDA:
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This is my declaration of Dom!cile and t.'iUJ011Ihip in the State of Florida tblat I am {iUnr thit day in ncc?rciAnee
and in conformity with Chapter 222, Section 222.11t Florida Statutu.
I wa3 formerly a lepl ~sident of
Richlth1d
(City)
Vir6inia
Slate
all') I resided '"
Box 246
. However, I hAve .,chanred my domicile
(Strco!t and Number)
to .,nd Rm an;\ hl\ve beer. a bonn fide resident ~ the Slate Qf Florida since
_ day ot
Novemb_er
58
19___ and I rei Ide at
2005 So 35th St
....
(Steet and Number)
}o'ORT PIERCE, SAINT LUCIB COUNTY, FLOIUDA,
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a'ld this slatemenl i!l to be taken as my declaration of dtiHnship, actual legal residence and domicile in the State of Floiida.
(Insert here any pertinent facts, such u sale of property or busine.ll, 01' rellnqu.i8hment of employment
at fonne( domicile, removal of family to new rlordcle. purchue of home. etc.)
Applying ~or homestead
1.1.3247
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I FURTHER CERTIFY that I will re.giller at my loal .ddre&l when the reclst.nltion beaks reopen, ll.nd comply
with HI! other requirements of a legel resident of this State.
I FURTHER CERTIFY that I hAve n~ intentioc. to return to my former domlelk, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentl7,
(Name)
Johnnie Milton Harris
(Address)
Sworn to and 5uh!~ribed ~fore me this
16 du ot
63 -
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(To be UKuk<!
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In dllpJlcate and .rffl~~ ,:~~~~ ~ ... lluplkak witll Tu~)
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ROGER POITRAS
-4'.RK CIRCUIT COURT
8, ~.g~
NoW, FubUe
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