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Declaration ot Domicile and Citisenship 12Z3s4
TO THE STATE ANO GOUNTY TAX ASSESSOR,
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Sl. lUC1E GOUNTY. FIORIDA: r,~`~~
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This is my decia~ation of Oomicile and Citizenship in the State of Florida that I am filirp this day in atoordanos and
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~ in aonformity with Chapter 222, Section 222.17, Florida Statutes.
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Bedlord Ohie °
I wss formerly a legal resident of -
~~i~y~ (Statej
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10~ Tarbell A~e.
. Howevei I have changed my domivle
and 1 rosided at '
(Street and Number)
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to and am snd have been a bona fide resident of the State of Florida sinae ZOth day of ~
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Ootober , 19 d~~ i ~eside er 209 Olive A~e. 81~er Park
(Street and Number) ~ -
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fORT MERCE, SA1NT LUCIE COUNTY, FIORIDA
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and this statement is to be taken as my declaration of citizenship, achial legal residencs and domicile in the State of Horida.
(Insen here any pertinent facts, such as sele of property or business, or relinquishment of employment
at former domicile, romovai of family to new domicile, purchase of home, etc.)
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Appl.Ting !or hoaeaLeod ~~~4
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1964 - ~ ~'~~?1(
Jri:d I6 Pti 2: 24
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~vt :;~o~;~~ ROGE~;
~~;~~v;t~;c~;.,r:''i': . ST. LUCIE COU~ti't~ CCEr?1f _
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I i FURTHER CERTIFY that 1 will r ister at my local eddress when the registration books rcopen, and ~omply with s~..~-
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all other rcquirements of a legai resident of this State.
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1 FURTHER CERTIFY that i have no intention to rotum to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAI{VT LUC1E COUNTIf, FIORIDA, permanently. f ~
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Thomea I~.a 3enders
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(Address) t
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; , Sworn to and wbsuibed bsfore ms this ~th 1-_::~Y?~F~ ~.TaIIU81'? , 19~.
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` CIRCUIT CO = • s ~ : Notary Public ~ ~
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gy dj~~; ~~N1Y G~titmission expires
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~ (To b~ ~oc~eut~d in duplleaN and ori~inal fil~d whh q~rk, qra+h Court, and duplieab with?Tax~ ~
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