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Declaration ot Domicile and Citi:enship 1~~5
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizenship in ths State of Florid~ that I am filinq this day in aooord~no~ ~nd
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal resident of Johnsto~na _ Nex York ~
' (Ciy) (~ate) .
snd 1 ~esided st 3~5 Wells Street . 1~{ov,rever 1 hsve chen~ed my domWle
(Street and Number) •
to and am and have been a-bona f de resident of the State of Florida since ;at day of ,
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DECEMBER 19~_, and 1 reside et ~•~Cie Ave, ~
~ (Straet and Number) '
ce~~T ~~eeE ~~l~tt ~uc~E ceu~tr; FLOR~nw
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and this statement is to be taken as my declaration of citizenship, actual le~al residence and domidle in ths Stats o~ Horida.
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~ (Inse~t here any pe~tinent facts, such as sale of properry or business, or relinquishment of employment ~ ~
st former domicile, removal of family to new domicile, purchsse of home, etc.)
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Applying for hanestead
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. . ~ . , FltE~ 1!~D RECOPOED .
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,.';t•~`s~v ; 1964 J:,;~ 24 AFI 10: 53
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:~~:d~; ° : ROGER P017f{AS. CIERK
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. cT. LUCIE CaUt~TT, FlORIOA j;~T
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I R1RTI~ER CERTIFY that 1 will re~ister at my local bddress when the registration books reopen, a~d oomply with ;I':
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all other requirements of a legal ~esident of this State.
1 FURTHER CERTIFY thst 1 have no intention to rotum to my former domic}le, and I intend to ron?ain in FORT
PIERCE, SAtNT LUCIE COUNTY, FLORIDA, pe~manentiy.
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(Name) _
Edxin Washbura ~ -
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Sworn to and wbsaibsd before ms this 24th day of ~ Januar't? , 19_~t.
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gY D.C. .:l~l':,,~s'slon :,~s~re`s~ ~ 0. R:
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(Te b~ ~ucvhd in duplicah and eri~inal fll~d whh d~elc•.Ci?a?it.•Co~~fR•~tid duplieN~ wHh Tax Ats~t~orJ
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