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Declaration ot Domicile and Citixenship
TO THE STATE AND COUNTY TAX ASSESSOR, 1431J6
Sl. IUCIE COUNTY. FIORIDA:
This is my declarotion of Domiule and Citizenship in the State of Florida that 1 am filing this day in accordanoe and
~n conformity with Chapter 222, Section 222.17, Flocida Statutes.
Charleston w Va.
1 was formerly a legal resident of
(Ciry) (State)
and 1 ~esided at 906 _MiSS10[l ROad However I have changed my domi~jle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ___~_~th day of
19 65and I reside at 211 North 40th
(Street and Number)
FORT PIERCE, SA1N? LUCIE COUNTY, RORIOA
and this statement is to ::e taken as my declaration of citizenship, actual legal residence and domicile in the State of Hwida.
(Insert here any perti~ent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying for homestead
IN~ EC Rg00K
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~ '66 MAR Lp~~2 • q
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? M ROGER P~i i t~~S. CLERK •
, ' ~ :'rt' ' ST. LUClE COUNTY.
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FLORIDA
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
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~ PIERCE, $pt1t~~[~1C~1~&C~1~VTY, FLORIDA, permanently.
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~ ~ Arnold ~.~rawford
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~ ist March 66
Sworn to and suburibed before me this day of , 19
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~ ROGER POITRAS
~ CIRGUIT COURT Notary Public
~ By d`"`~'`"L ~a'~-'~-~` D.C. My Commission expires
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~ Ro b~ ~x~cui~d in dupliut~ and oripinsl filed witl~ Cl~ek Grcuit Cou~f, and dupliu» witb Tax Ax~ssor.)
~ dooK 139 393
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