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Declaratiore ot Domicile and Citizenship
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TO 7HE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This ~s my declaration of ~om~cile and Citizenship in the State of Florida that I arr? filing this day in accordance and
in conformity with Chapter 222, Sectian 222.17, Florida Statutes.
New' York Cit y New Yo rk
I was formerly a le9a't resident of _ . - - - - - -
(City) (Sfafie)
and 1 resided at _ 7343 7~th $tlCet ~ BIOOk1yIl 27 However I have changed my domiG4le
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since 15 _ day of
_~anuary ~q__63 and I reside ar ~318 Orange A enue
- . -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stalement is to be taken as my declatation of citizenship, actual lega! residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale oF property ar business, or relinqu~shment of employment
. at former domicile, removal of family to new domicile, purchase of home, etc.)
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Establishing residence RBG
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ST. LUC~E C0~ ~~E~K '
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i FURTHER CERTIFY ihat I will comply with al! 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 LUC{E COUt~lTY, FLORIDA, permanently. .
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• t - (Name) ~
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: E~ward Speiser _ J
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> (Address)
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Sworn to and subscribed bef~re me this __-____-._4 day of ~~~~b~~ ~q 65
ROGER PO TRAS
CLERK C UIT tOURT Notary Public
gy . _ ~i~__.____~~ D.C. M~y Ccmmission expires
(To be sxecuted in duplicale and or~gina) fiied with Cte~k ~Circuit Covrt, and dupliuts with Tax Assessor.)
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