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De~laratlon ot Domicile and Citisenship
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TO THE STATE ANO COUNTY TAX ASSESSOR.
ST, LUCIE COUNTY, FLORIDA:
This is my declaration of Domicite and Citizenship in the Ststa of Florida that 1~m f1llrp this day in aooo?danq ~nd
in conformity with Chapter 222, Section 222.17', Florida Ststutes.
I was formerly a ieflal resident of ~~li~BburR _ HBY~I~e?i'~~
(City) l'Star.)
and 1 resided at 6~ ~rlisa Ave. ~ . How,~ver 1 have chsnged my domk3l~
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ro and am and have been a bona fide ~esident of the Stste of Ftorida si~os 19t,b ~y ~
, 19~. a~d I reside at Rt 2 Haoc 2'r63~20 I.skexood Park .
(St~eet and Numbe?)
~w~~!T ~~~r~s cAU~tt'1ti ilAR1~/? .
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and this statement is to be taken as my declaratton of citizenship, actual leyal residenoe and domidle In ths Stste of Horida.
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-{Insen here any peninent facts, such as asle of properry or bustness, or relinqulshment of employtnent
at former domicite, removal of family to new domicile, purchase of home, etc.)
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Applying fo "r hanestead ~
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I fURTHER CfRTiFY thst 1 will ~egister at my local address when the registration books reopsn, and oompty wlth '
alt other requirements of a legai resident of fhis State. , ~
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1 fURTHER CERTIFY that 1 have no intention to return to my formeir domiGle, and I intend to romain i~ FORT
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permsnently.
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Verne J. o"1°ry 3r
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U~ddress) -
Sworn to ~nd wbscribsd bsfors ms this 2~eth ~y ~ , Janusry 196~ .
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CIR R COURT . ';,;;i:~,~•' : : . F:~ ~ NqaaTy:Pubik ~
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BY • . ~1~1CPo"!nt~~oo ~ycpiro~ 0. R ~
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(Te b~ ~oc~aM~d in dupqcaN and eri~in~l Bl~d whb Cl~rlc Grcvit Couet;'and dvplicaN whh Tax Ass~aera
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