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Dectaration ot Don~icile and Citizenship
TO THE STATE AND COUNTY TAX AaSFSSOR,
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Sl. LUCf~ COUN"CY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chepter 222, Section 222.17, Florida Statutes.
New York
I was formerly a legal resident of _ C1_aY_ _ . _ _ _~__r-
(Ciry) (Stab)
and I reside.~ at Lake_ Shore_ Drives __R~_ D._ #3_ _ However I have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since __ls~ day of
July ~ q 6~, and I reside ar ___1608 Zeph~yr Avenue
(Street and Number) ~
F4RT PIERCE, SAINT LUCIE COtiNTY, FLORtDA
and this statement is to be taken as my declaration of citizenship, act~al legal residence and domicile in ihe State nf Florida. '
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of hame, etc.)
My wife and I have sold our bome in Clay, New York, and
have purchased a new residence at 1608 Zephyr Avenue, Fart
Pierce, Flo=ida.
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F~~~~ AND
tN_. REC ROEO
BOOK
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_ . ~UC1~ ~p~NrYRK
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~ FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Sfate.
t FtJRTHER CERTIFY that I have no intention tn return to my former domi~ile, and f intend to remain in FORT
PIERCE, SAINT LlJCIE COUNTY, FLORIDA, permanently.
(Nam Alfred J. Hicks V
~ 160$ Zephyr Avenu~
Fort Pieicde,eSFlorida
Sworn to anc~ subscribed before me this -~th~__~ day of _~~ember ~q 65
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ROGEit POITRAS ~-rt~,?~C.~~? ~
CIERK CIRCUIT COURT - ~ , . ' -
Notary Pub(ic ' .
~Y - - _ D.C. My Commission expires ..~.b w .
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(To be ~xecuted in duplicate and a?iginal ~led weth Ciaric Circuit Court, ~nd duplicate with Tsx Ass~ssor.)
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