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Dectaration ot Domicile and Citlsenshlp 148~83
TO THE STATE AND COUNTY TAX ASSESSOR~
Sl, IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acto~dante and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of philadelp_hia Pennsylvania
(Cify) (StaM)
end I residcd at 4~?4~ E. ThOmpsOn Ho,,,,ever 1 have changed my doanitile ~
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since 32 day of
_~.Bugu~~______ , 19^~i6 and I reside at _ 806 S. 12th Stteet
- (Street and Number)
FORT PiERCE, SAINT LUCIE CONNTY, I~ORfDA
and this statement is to be taken as my declarotion of citizenship, actual legal residerxe and domicile in the State of Florida.
(Insert hera any pe~tinent facts, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
Fit,~o ANO RECOROE~
Est~blishing residence ST• ~-~~IE COUNTY F
R~~ R~ VERIFIEp~.
!66 S`p 20 A~1 Ir~ ; 22
~ 148~83
~ ~OGFP, i•OITRtig
~~ERK. G~R~V~T COURT
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of thia State.
I FURTNER CERTIFY that 1 have no intention to return to my former domicrile, and I intend to remain in FORT
PIERCE, SAINT.LUCI.E ~OUNTY, FLORIDA, permanently.
. ~,,~~:S1GNtl!/!/~~``~i'~'. '
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' (Name)
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. Dominick G. Beben Honora Beben
' ; ~ y. (Address)
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Sworn to and subscribed before me this Z~ day of September ~ 19 66
ROGER PORRAS
CLERK CUIT COURT Notary Public
~
By D.C. My Commission expires
(To b~ ~x~cuted in dupliut~ and ori~enal fil~d with C{~rlc C~rcuH Court, and duplicat~ ~iriN~ Tax Ass~sto?.)
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