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Declaration of Domicile and Citianahip ~t!<<
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'57 '~b~423
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TO TilE STATE AND COUNTY TAX ASSESSO~
ST. LuCn~ COUNTY, FLORIDA:
This is my declar~tion of Domicile and Citinnship in the Sble of Florida Urat 1 am m;ng this day in accordance
IIIllI in ronformity wit~ Chap~e: 222, Section 222.17, Florida Statutp.s.
I was formerly a legal resident of
Milton
New York
State
(City)
'"
Latten Town Road
nn I I re"j;fe<l at
(Street and Number)
However, I h.we changed my domicile
to an.1 Rill nnd have been a b:ma fide re~ident of the Slate of Florida !ince
13th
day of
October
61 307 N l2thStreet
. pnd I reside at
19
(Steet and Number)
FonT PIERCE, SAINT LUCIE COUNTY, .'LORInA,
...
11':<1 lhi" "tatl'ment is to be t&ken as my deelaratlon of C'!thenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facti!, such as sale of property or business, or relinquishment of employment
nt fonner domicile, removal of family to new comic1e, purchase of homp, etc.)
Applying for hOmestead
113414-
fILED ANO RECOROEO
\P,.OHidal Recoul- nOOK
\%3 rEa 22 PM 2: 28
ROGER POIIRAS. CLRKA. I,'
Sl. LUCll COUNn. FLO,V .
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I FU RTIIER CERTIF Y that I will register at my local address when the registration books reopen, and comply
\\i:i, 111' other requirements of a legal resident of thi!! State.
I FUInHER CERTIFY that I have ToO intention to return to my former domicile, and I intend to remain in
FOI~T PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
HIS
/YI ".~, (N.moli t (7! c)
James ~u ~ me r~o
~~ J)-G~-P1:a
(Address)
K
~\,,(1:n :0 nd ~I.lh:,cribed before me this
22 da.yof .... FeD..
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,19 63
HOGEH POITRAS
CLERK (;IRCUlT COUR~
By .-/-~'{~L -d-~
~TII he ae<uted In duplicate and original (lied with Clerk CI~ult Court, ,.nd dupUeate with Tn J..asemor)
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