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Declaratton ot Domicile and Citisenship °
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: ~~3v
This is my declaration of Oomicile and Citizenship in the State of Florida that t am fiting this uay in eoeordance and
i~ conformity with Chapte~ 222, Section 222.17, Florida Statutes.
Lincola Park Hich
I was formerly a legal resident of
(City). (State)
and 1 resided at 170'.S BUCkiQhBID Ave. However 1 have chsnyed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Ftorida since Sth day of
_~u~u5t , 19 and I ~eside at 154 P18Cit8 Crt.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Slate of Horida.
(Insert here any perti~ent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removai of family to new domicile, purchase of home, etc.)
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Filing for Homestead purposes
RDED
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UCfE COUNTY.
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1 FURTHER GERTIFY that I will comply with all other requirements of a(egal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT '
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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,/SaioYn.Jb end subscribed before me this 24tb day of Pebruary ~q 66 .
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ROGER r0
CIERK CI CU URT Notary Public
.
gy D.C. My Commission expires
(To b~ ~oacut~d in dupliut~ and ori~insl ~il~d wlth Clark Circuit Couirf, and dupiicat~ with Tax Asw~or.)
` . ~13~9 ~93
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