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Declaration ot Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORi~A:
This is my declarotion af Uomicile and Citize~ship in the State of Florida that I am filing this day in acoordanoe and
~n conformity with Chapter 222, Section 222.17, Florida Stah:tes.
1 was formerly a legal res~denr of _~unt Rainer _ Marvland ?
(Ciy) (Staro)
and 1 ~esided at APt 4205 Ruise 11 A~e. Ap~ #6 ~Wever 1 have changed my domic,ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~t day of
_ December__ , ~q 65~ and I reside at 242 So. 20th St.
(Street snd Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Stab of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of hame, etc.)
New Domicile
;`.~~~~::ti:r~ ~~~~AiAiiY RE ORpE~
; • 900K
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`~:.v;.1;~•;~=; a' 66 3 yy •
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_ .4 ~ 3~5~
, -,.~t=;";~`r•~.'~ = R~GER P ,
~ 01 i RAS, CLERK
; . " ST. LUCIE COUNTY.
` ' ~ FIORIDA
, ~
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I RIRTHER CERTIFY that I will oomply with all other requirements of a legal resident of thls State.
1. fURTHER CERTIFY that I have no intenfion to return to my forme~ domicjle, a~d I intend to remain in FORT
PIERCE;~$AINT LUCIE COUNTY, FLORIDA, permanently.
~4~t:::,,~orr:
. ~ • * : ~rf i.
"r ~ . James Bsco Hood
~ - • • ~ • (Name)
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~ ~ ~ ~ J i: .Ti ;
~ ` (AcJdress)
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.1~°`'~ 3rd March 66
SWb~n to ~and suburibed before me this day of , 19 .
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
By ~i~~.-»ilL ~~!!'~O~'~ D.C. My Commission expires
lTo b~ ~x~cvt~d in dupliu» and oriyinsl fil~d witb q~rlc tiraiit Court, a~d duplieat~ wiN~ Tax AsMaorJ
eooK139 _ 48S ~
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