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DeclaratWk~~~i~p
,
TO THE RTATE AND C01.JNTY TAX ASSESSOR,
ST. LuCIE COUNTY, FLOnIDA:
This is my declaration of DomleU. aDd CIUlenJhip In the State of Florida u.t I 1m flllnc tbla dq in aeeorUaDc.
,
and in conformity with I::hapter 222, Section 222.17, norida Statutea.
I was Cormerly a lepl resident of
A NNANDAIZ
VA.
State
( City)
an.! I resided at 741? MoWhorter Pl.
(S..reet and Number)
However, I have ehautred mJ domiei1e
to Rnd am and have been a bona fide resident of the Slate of Florida alne~
14th
day 01
Deoember
"
19 62 . and I reelde At
151 Prinoess '. J)r.
(Steel and 'Number)
FOHT PIERCE, SAINT LUCIE COUNTY, FLOB1DA..
,
0:'<1 lhis statement is to be taken 8S my declaration of cltiHnship, actual legal reaideDee and domicile in Ute State of Plorida.
(Insert here any pertinent facta, lI\:eh .. sale of Propertl or buahiela, or reliDqw..hlnent of emp1oJD1eD\
at former domicile, removal of !amlly to new domlcl., purchue of home, etc.)
Filing for Homestead Purposes
t
1.1.3350
FILED AND RECORDED
\~IO~BOOK
1963 FEB 2' AM 10: 08
ROGER POITRAS, CLERK (\ ~
S1. LUCIE COUHTY, fLORIOA~ -..
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1 FURTHER CERTIFY that I will reglJter at my loeal addrelll when' tM reaiatraUon boob reopen, and ~p1y
with all other requirements of a legal resident of this st8u.
I FURTHER CER'fIFY that I have no intention to retunl to Jr.~ former domicile, aDd I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, perma~en ~/
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" (/4 7( 1A'F~__/L.~I -~J-?
(Name) ~
Thomas R. W111(\ughbY'
(AtldreM)
.21
day of ~brU&ry
63
,1i_
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..... Notu7 P-.Uc
D.C. Wy CommlJ.lio1l expirtI
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(To be executed in duplicate and ort,lna' fileet with Clerk Ctrntt. Cout, aM nplicde wtO Tn A:...~TI -)
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