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Declaration ot Domicile and Citizenship ~
143521 i
TO THE STATE ANO CC)UNTY TAX ASSESSOR, ~
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51. LUCIE COUNIY, FIORIDA: ~
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This is my declaration of Domicile and Gitizenship in the State of Flo~ida that I am filing this day in acoordante and
in confo~mity with Chapter 222, Section 222.17, Florida Statutes. {
1 was formerly a legal resident of -___~atl~_. I11~II41s -
(City) (State)
and 1 resided at __~_T_ 1215 1~8Shington ~„1ever 1 have changed my domic~ile
(Street and Number)
to and am and have been a bona fide ~es+dent of the State of Flo~ida sincc day of
Janu ary S9 1117~- S~ Ocean Drive
- , 19--, and t reside at
(Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, adual lega! reside~ce and domicile in the State of Florida. -
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment `
at former dornicile, removal of family to new domicile, purchase of home, etc.)
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Homestead exemption FtLEO AND RECORD~D `
rM 8 OK E
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~''z~~ ~~.'`ca~. '66 MAR 1 I P~! ~ §
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- ;'.;s'~.,.:.; ~ _ ROGE~ PO! ~ RAS. CLERK -
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- ` ` ~~~.s=`:': _ ST. LUCIE COUNTY.
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1 FURTHER ~ERTIFY ihat 1 wil) comply witfi a!I other requiremenis of a legal resident of this Siate.
I FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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' . Y:i ' ~ (Name)
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_ r~"• " Willism F. Wa
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:'r~ ~Y~ tp~i~ ~subscribed before me this day of March ~~q 66
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ROGER POITRAS
CLERK CIR IT COURT Notary Publit
SY D.C. My Commission expires
(To b~ ~x~cut~d in duplicat~ and oripinal fil~d with Cbrk qrcuit Cour~, and duplicat~ witb Tax /1~or.)
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