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Declaration ot Domicile and Citizenship ~ {
TO THE STATE AN~ COUNTY TAX ASSESSOR. 1431~2
51. IUCIE COUNTY, FLORI~A:
This is my declaration of Oomicile and Citizenship in the State of Flo~ida that 1 am filing this day in acoordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was fo~merly a legal resident of --AShl~d_ „_-____-Kt'1]tUrj~t
(City) (State)
and I ~esided at -___3027 ShutE StrCet However I hsvechanged my domicGle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _________15.~_ day of
_ __Au~ust ~ ~q_65 and I reside at 1704 Edgevale Road
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fiORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Inse~t here any pertinent facts, such as sale of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
.
rN RECORp~D
~~~,;~~~=~+:r~:::.;~, Applyin~ for homestead ~DOK
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I FURTHER CERTIFY that I wil) oomply with al) other requirements of a(eyal resident of this State.
I FURTHER CERTIFY that 1 have no intention to retu~n to my former domicjle, and I intend to remain in FORT
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~ PIERCE, SA~(~1~j=~;}~~IE COUNTY, FLORIDA, permanently.
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~ = ~ = (Name)
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: y~ ~ George 1~I. Barber
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~ , Janet ~dbei
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~ ~ Swor~t to and subscribed before me this lst day of ~rCh ~ 19 66
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~ ROGER POITRAS
CIRCU COURT Notary Public
~ B D.C. 1~:~ Commission expires
(To b~ ~x~cutad in dupliut~ and oripinal filed with G~rlc Grcuit Court, and duplie~h witl~ Tax Aa~ss~.)
~ eooK 139 389
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