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Deciaration ot Dor~ictle and Citizenship
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TO THE SYATE AND COUNtY TAX ASSE550R,
~_~.si7. }.)i:?
Sl. LUClE COUNTY, FLORIDA:
This is my decleration of Domicile and Citizenship in the State of Florida that I am filing this day in eccordance and
in conformity with Chaptcr 222, Settion 222.17, Florida Statutes.
I was formerly a iegel resident of SCiT~d~lt V _ N~MI York _
(Ciry) (State)
and I resided at ___B8TC1~? RO~d_________ . However 1 have changed my domiCile
{Street and Number)
to and am and have been a bona fide resident of the State of Florida since 1$~h_ day of
Apri~_._,______, ~q__64 and I reside ef 326 Naran~a ll~e. Pt St.Lucie _
(Street and Number)
FORT PIERCE, SAtNT LUCIE COUNTY, RORIDA
and this siatement is to be taken as my declaration of citizenship, actual I~gal residence and ~iow;~:.ile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of e~;ployment
at former domicile, removat of family to new domicile, purchase of hom~, etc.)
Bstablishing residencc . ~~~-E~ ,~1D RE~pROED
iOQK
wi11 apply for homestead
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_ _ 5i~. ~U~l~ C+OUtvTY,
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1 FURTHER CERTIFY that I will com~ly with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAIN7 LUCIE COUNTY, FLORlDA, permanPntiy.
: ~ : Zi-- ~ ' Li ~ _
• ~ (Name) ~
~ ~ ohn W. Ha~ford
- . ~c~ .n
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K.arin S Hamford
, . 27th ~~ugust , 19 6S
Sworn.~o;anc! subscribeci before me this - day of •
ROGER POITRAS -
K CIRCWT URT Notary Public
D.C. My Commission expi~es
{Ya bs ~xecutad in duplicate sred origin~) fited witl~ Clerk Circuit Covrt, and duplicats w8th Tax Ast~ssor.)
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