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Declaratidil~~~ !?~~~~ f.'~t\ .Citizenship
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TO TilE STATE AND COUNTY TAX AS5F:SSOR,
~T. LL:CIE COU-iT\', FLORIDA:
This is my declaration of Domicile and Citizenship III thQ Stn te of Florir.la that I am f;ling this d"y in accol'1.lmlcL'
ar.d in conformity with Chapter 222, Section 222,17, Florida S l:.tutes.
....
N. J.
llIIlI:lI1
DOVER
I was formerly a legal resident of ~
[City]
State
and I resided at_J9 Liberty.St'----.--..
[Strect and Numberl
to and al11 and have been a bona fide resident of the State of Florida since
. 1I0wc';er, I have changed my domicile
3.rd
...
doy of
Dee efil ber
809 Emil Ave.
062
19.... __, and I r('side at
[Street and Nu-nber]
lo'ORT PIERCE, SAI!'T LUCIE COUNT\', FLORIDA,
;lr.d this state:l1cllt is l'; be taken as my d.'dar;:t:on of citizenship, actl:ai Ii'!:al l'esideJ.':e ard dumicile in the State of FloI'idn
rrnsprt h(;re a'~y pc:,tinc:ll fad;, su'h a,; sll~ of property or busincss, or :-elinCjllish:-:1C:lt of e:npluyrnent'
at fornler domicile, rC:l1o';al of f:H11i!y to new domi I.,: p T,'h:15(: of home, ctc, J
...
FILING FOR HOMESTEAD PUREOSES
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I FUHTHF:Il CERTIFY that I will rcgister at my local <:~ldres:; whcn th~, re:.::stral1'~;n b:oks !'eope:l, and co:nply
with I'll other re:juirements:J1 a Jec;al resident of thi:; State.
I FL:RTIIEr{ CEI~TrFY that I h:1\'[' n:> intention to returr. to my former dO!T1icile, and I inten:l to rL'::~3in jn
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
permanently,
-L~~~L_i~~/c~~ .
[Name]
DWIGHT R. :'ORROW
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[Address]
..
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30th
__ _ El 6.3
jay of _MarQJL.____h____
'Sworn tQ ;H,<i subscribed he fore me this
1'(;(: f"P' POITR,\S
'y 9~)2JTi~~~:li;1~ DC
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I
~ot:t:.y Public
:-'f:; Conlmis.sion C":pi:-e:; -..-
(To be executed In duplkate and origin'll fIIe:l with Clerk Circuit Court, and dllpllmtc wllh Tax Asst'Ssor]
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