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Declaratio~ ot Domicile and Citizenship 1432f3~3
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was fo~merly a legal ~esident o~~ster Ba~L. I_______ N vork _
(City) (State)
and 1 resided at __19 Spring Street _ However 1 have changed my domicale
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ___1St day of
September___ ~9b~, and 1 reside at 116 Bast Arbor
(Street and Numbe~)
FORT PlERCE, SAINT lUC1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applyin~ gor Homestead
' ,J;~•: '~FIL A Q ECO DEO
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L~~OOK
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. . ROGER P'
~ u1Tn.~5. CLERK
' • ST, LUCIE GOl1NTY.
. ~ FLORIDA
I FURTHER CERTIFY that I will cornply 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
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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1 (Name)
- - • ~ ~ Jean Pierre Blanchard
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Swor`n'to'and subscribed before me this 4th day of ~rch , 19 66
ROGER POITRAS
CIRCUIT COURT Notary Public
g D.C. My Commission expires
Ro b~ uacut~d in duplicat~ and oripinal fil~d witl~ CIKk Circuif Court, and dvplicata whh Tax Aswssor.)
- aooK 139 524
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