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Declaratlon o! Doinlclle and Citisenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, 1435U5 ~
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship i~ the State of Flo~ida that 1 am filing this dey in acco~dance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal ~esident of -_~kLO1L-. Qhio
(Cify) (S1ab)
and 1 resided at _
389 St 1@ e I Ave. 1~Wever I have changed my domitile
(St~eet and Number)
to and arn and have been a bona fide resident of the State of Florida since 15th__ day o~
_ November ~ 19 65 , and I reside at 503 Holly Ave.
(Street and 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 State of Horida. ,
(Inse~t here any perti~ent facts, such as sate of p~operty or business, or relinquishme~t of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
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_ ~ " ~r , ~.~pplying for homeatead
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I FURTHER CERTIFY that 1 will oomply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no inte~tion to return to my former domicale, and I intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORiDA, permanently.
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. -,''~~~p~'. (Name)
E - ~~1 = Wi11ie C Sherrill
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,,"'~;~'t' ~ : ~ ~ llth March 66
•...$wam to and subscribed before me this day of ~q ,
.
ROGER POITRAS
CtRCUtT COURT Notary Public
8Y D.C. My Commission expires
Qo b~ ~x~cutsd in dupljcat~ snd oei~insl fil~d wlth Clerk Cirwit Cou~, and dupliut~ with Tax Ass~ssor.)
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