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, ~ De~claratlon of Domicile and Citizenshlp
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TO TWE STATE AND COUNTY TAX ASSESSOR, ~
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~ Sl. lUC1E COUNTY, FIORIDA:
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' This is my declaration of ~omicile and Citizenship in the State of Florida that t am filing this day in accordance and
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~ ~ ~n conformiry with Chapter 222, Section 222.17, Florida Statutes.
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' + S uth ~arolina
~ I was formerly a legal resident of . _ HO11'rMOOd _ _ _ :
(Ciry) (State)
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~ ROUtL 1~ YOUtl~*S I~ltnd__ _ However I have chan ed m domiGile
. and I resided at - - _ . - _ _ _ . 9 Y
~ (Street and Number)
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ro end am and have been a bona fide resident of the State of Florida since . 22 day af
gu 128 N 13th Street
, _ Au__ st_ _ _ . 19bs__, and I reside at
(Street a~d Number)
FORT PtERCE, SAINT LUt1E COUNTY, FLORIDA
~ and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flarida.
~ (Insert here any pertinent facts, such as sale of property ar business, or relinquishment of employment
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. at former domiciie, removal of family to new domicile, purthase of home, ett.)
FIL ,~N ~4ECI~R~EO
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~ ~OOK
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j Bntering 3 children in Fort Pierce blementary '65 ~ 25 p~~ ~ 23
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1 child in Dan 1~cC~rt1~ High School ! ~•~i:;;;>. CLE~~K
~ F. LUCIE GOUNTY,
~I.ORIDA
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I FURTHER CERTIfI( that I will comply with all other requirements of a lega! resident o~~}i-.Stafe,`~ ,
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1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I interid'to, remein:,~n FORT
PIERCE, SAINT LU~IE COUNTY, FLORIDA, permanently.
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, ~ ; ~ (Name)
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o : ~ . Joe Piep~r
~ _ ~ ~ ~ (Address)
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_ ~ 25 3S August 65
„ ~$~++/qrntti~l ~$nd-wbscribed before me this day of , 19 •
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ROGER POITRAS - -
C K CIR T COURT Notary Public
6y ~ _ ~ D.C. My Commission expires _
(To o~ ~xecW~d ir~ duplicate and ariginsl filsd with Clerk C+rcuit Court, and duplir.att with Ta~c Ass~sor.)
_ Bu~K :~5 29~