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Declaration ot Dornicile and Citizenship ~ }
TO THE STATE AND COUNTY TAX ASSESSOR, v,~'"~
Sl. IUCIE COUNTY, fLORIDA:
This is my declaration of Oomicile and Citizensfiip in the State of Florida that ! am f;ling this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of . ~~~'a~E - ~
~~;ty~ (State)
and 1 resided at __~~N•_. ~!~~1___ _ . However I have changed my domiCile ~
(Street and Number) T ~
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to and am and have been a bona fide resident of the State of Florida since _ L'--_ day of j
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U~' L s~____ 19~_'~'f__, and 1 reside at .111C Cltib Dr1Y@ t
(Street a~d Number) i ' i
FORT PiERCE, SAINT lUCtE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
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at former domicile, removal of family to new domicile, purchase of home, etc.) ;
Filing for homestead purposea
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Fll AN ~ eE'C~~R~ O~K
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ST. LUCI RC~OA Z~TY.
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1 FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State. ~
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I FURTHER CERTIFY that I have na intention to return to my former domic,ile, and I intend to remain in FORT ~
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PIERCE, SAINT CUCIE COUNTY, FLORIDA, permanently. ;
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j ~ ~ I~„ (Name) :
~ David M. Bleeeh ~
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~ t•+?' . ' . - (Address) ~
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,~S~,rqtn'•ib and subscribed before me this $th day of ~areh , 19 66 '
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! ROGER POI
i C CIRC COURT Notary Public
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~ gy D.C. My Commission expires
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~ (To be oxecu ' duplicate and originsl ~ilo
Rwith Ge~{c Circu165
, snd dupliub with Tax Asses~or.) #
` ~ooK 140 ~
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