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' 14'~815
' Deciaration ot Don~icile and Citizenship
TO THE STATE AND ~OUNTY TAX ASSESSOR.
Si. LUCIE ~OUNTY, ftORI~A:
Thia is my declaration of Oomicile and Citizenship in the State of Flo~ids thet 1 em filing this day in aaordante a~d
in aonformity with Chspter 222, Sectio~ 222.17, Flo~ida Statutes.
~ t was formerly a iegal ~esident of BaYsbOre LOpg Is~and~N.Y.
~ (City) . (State)
and !.•esided at SO1 BaSt MB~in S{. Hc",~ever 1 have changed my domivle
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 20th ~ day of
June_ , 1966 , and ~ reside ar 606 Beach Ave. Port St_ L~cie
(Sheat and Number)
FORT ~l~CE, SAlNT LUCIE COUNTY, tLORIDA
and this sti~tement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
Qnsert here any peninent facts, such as sate of property or business, or relinquishment of employment
at former domicile, removat of family to new domicile, purchase of home, etc.)
Bntering One Child ~n School - Robert Helrigel
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FILEO AND RECORQEO
: ST. L.UCIE C4UNTY. FLA. ~
RECORD VERIFIEO I~/L,
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~~6 ~ 19 Al~f 11:35
14'~815
~sOGER F'OITRAS
CLERK CIRCUiT COURT
1 FURTHER CHtTIFY that I wili oomply with all other requirements of a(egal resident o; this Sfate.
- I FURTHER CERTIfY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
F PfERCE, SAINi•LUCIE COUNTY, FLORIDA, permanently.
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~'~j~';~'` Albert Edward HelriQel
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Sw~rn ta-and subscribed before me this IQth day of - August ~q 66,
.
RdGER POITRAS
CLERK CIRCUIT COURT Notary Public
BY ~~r D.C. My Commission expi~es
(To b~ ~x~cvt~d in dupilc~st~ sed ori~inal ~il~d with q~ek Cirwh Court, and dupllcat~ with Tax Assessor.)
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