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Declaration of Domicile and Citizenahip
ib~k 57 pm 312
TO TilE STATE AND COUNTY TAX ASSESSOR,
-""I. r'
'. ~TI LUCIE COUNTY, n~.
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ST. LuCIE COUNTY. FLORIDA:
This is my declaration of Domlclle and CitlEensblp in the State of Florida that 1 am filin&, this day in aceo.dance
ILIIJ in conformity with Chapter 22~. Sectivn 222.17. FloridA Statutes,
I was formerly a legal resident of
SPRINJFIELD
(City)
MASS.
Btate
'"-
',,"-
!Ill I I rc,;j,h:d !\t
98 'delli.ogton St.
(Street and Number)
However, I have changfld my domlelle
29th
day of
to unci 11m and hllve been a b:lIla fide resident of the State of Florida since
December
III 82 . and 1 reside at
....,.
40E Airoso Blvd
(Steet and Number) .
.....
FOHT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
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a:..1 Ihi, ~tatemcnt is to oe tp.ken as my declaration of ciUsenship, actual legal residence and domicile in the State of Florida.
(1n~crt here any perti..cr.t facts. such as sale of property or business. or relinquishment of employment
nt former domicile, removal of family to new domicle, purchase of home, etc.)
Filing for Homestead purposes
,'}.iI,.,
.j.-.
I FL'RTlIER CERTIFY trat I will register at my loeal address when the rei'lstnUon books re<>pen, and comply
with all dhl'r rcquirell1cnts ot II legal resident of this State.
1 FURTHER CERT!FY that I have no intention to return to my former domlcia, and I intend to rerurJn in
FORT PIERCE, SAINT LUCIE COUNTY. FLORIDA, permanently.
f ""A: /1r ~
~ (Nam!)
Hazel M fiiril Curran
(Address)
.....
"
Sworn to nllil "ub~cribed bef(,re me this
,1963
~TJ be cX".:uh'd In duplicate and oril!na.
ROGER POITRAS
D~:CIZ~
; ;: Notary Public
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