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Declaration
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8~,~ K lACE l.
ofS P~mffi~~l!~H~ r5i.t~en8hip
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11.4244.
TO TIlE RTATE AND coUNTY TAX ASSESSOR.
:iT. LUCIE CoUNTY. FLORIDA:
This ls my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in acx:ordauC2
and in conformity with Chllpter 222, Section 222.17, Florida Statutes.
Saxton
Missouri
I \Va.! formerly a legal resident of
[City)
State
112 Wakefield Drive
[Street and Number!
to and am and have been a bona fide resident of the State of Florida lince ----
and I resided at
However, I have changed my domicile
1
day of
April
62 211 N. 39th Street
19_ ~ and I relide at -
[Stre-et and N\lI11ber)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA.
ar.d this state:nent is to be taken as my declaration of dtizensh ip, actual legal residence an:! domicile in the State of Florida.
[Insert here any pertinent facts. such as S:lle of property or business, or relinquishment of employment
at f6rmer domicile. removal of family to new domicile purchase of home, etc.)
Applying for ho.:..este88
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.11.4244
fiLr~r MID RECORDEC
Ir O,t\~\~\. Record ~~um<
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ROGER POlTkAS, ClEril<. -
SI. LUCIE CoU:I1~. t LO ;t10 A . .1/
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I FURTHER CERTIFY that I will register at my local address when the reICistration b:>ok5 reopen, and comply
with all other requirements of a legal resid~nt of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
FORT PIElt(;:4;' S{UNT LUCIE COUNTY, FLORIDA, permanently.
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[Name] )
Herbert Fi!1n.ey
[Address]
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Sw~,~~,' ~n~~.t>'scrlbed before me thl~
ROGER POITRAS
a CL~RK crCUIT COURT
?W"'- I~_
Ma.r...c h
19----63
25
:lay of
Notary Public
D.C,
My CC'mmission expires
3y
[To 00 executed in dupllcate and orlgln:\l filed with Clerk Circuit oourt, ,.nd dupUc,&te with Tax ~rl
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