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DeClaratiotf pf DpQ1iAle .aqc.l.Citize~hip
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II} T!l~: :-;TATL AND COl':\TY TAX ASSESSOH,
:-,1 I.l \ IE ('Ol':\TY, FLllIU\):\:
a:,,1 ", ,","hrrnIty with \ 'hapter ~:!:!, S,'dioll :!:!~,17, Florida Statu!l'~,
TJl1~ hIllY dl'.'laratioll of \lolllil'lle and Citi_Nlship ill tIll' Statl' uf Florida that I !1m fdInK this day in 3cc(,nlancl'
I w:" jorllwlly a legal resldellt oj
DaytorlB Beach
(\ 'Ity)
Fla.
State
Iluwe\'t.'r,
I han' ,'han~l'd my domicile
~ 1 rt" 1. :t',j at
502 Phoenix Ave.
18th
day of
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':-;,I['et al,,1 :\umher)
t. :',lId :!11I ,":d I,:!\,<' 1><l'lI " 1>,,,:a fie!" J('"ioll'll( of the State of Flonda s""'e
Marfh
::J 63 ,alld I reside at
140 El Sito Crt
(Steet and Number)
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a d tillS ,tall ,,;\'n'. i, 10 hl' takell as my d['{'laration of citizer,silll), actual legal residence and domicile in the State of Florida.
i'(IHT I'IEIH'F. S.\I:'\T Ll'CIE COUNTY, FI.OHII>A,
lit former domicile, remond ,,[ farnil~' to new domicil', purchase of home, etc,)
111l'l'rt bp,<, allY pel.tinent faels, such ao; sale of prop!'rty or business, or relinqui~hment of employment
Establishir~ residency
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\\,:':, ,,!, ,t!wr l'l";Ulrell1C'lll:; of a legal resident of this State.
1 I'l'f:T1IEI: ('I:RTH Y that I will n'gistpr at my local aduress when the registration books reopen, and comply
I'lll:T l'iU:('l':, SAI~T LUCIE COUNTY, FLORIDA, permanently,
I Ft'I:TIlEH ('EI{TIFY that I have nil intention to rl'lurn to my former domicile, and I intend to remain in
y
:;f V.
F.
v. Webb
<'.I'lIi n 'f! an,! ,uh,.cribl'd uC'L,rp me thi:!
1st
day of
HOC E I: j'OITIL\:>
I)I':HK IlRlTIT ~;OUHT
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rtle<b;'fjh,~~'bit Court,
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('I'll be P:Hcutl'd in duplicate and originlll
~
It
(Aduress)
April
, 19
63
Notary -Public
expires
and duplicate with Tax A8se8I'Wr)