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De~larAtion o! Domlcile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~Q~~
5i. IUCIE COUNTY, FIORIDA: ,
This is my declaration of Oomicile and Citize~ship in the State of Flai~ia thst I am filing this day in aaordance and
in conformiry with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly a legal resident of ~u13Ville Yentuckp
~C~y~ (State)
and 1 resided at 5611_ Nclly COUrt _ However 1 have chan~ed my domic~le
(St~eet and Number)
to and am and have bee~ a bona fide resider~t of the State of Florida since -.l~th_ day of
Sept , 19 66a~ ~ reside at 501 Holly
' (Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, FLORI~A
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Stste of Horida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new dornicile, purchase of home, etc.)
Bntering Timothy T-ee Mi~ods in the lst grade of school
Bstablishing residency
ST.R
C ENCOUNTY RL
ECORO VERlFI~O
'66 SEP 23 pE1 1: I 2
148r~2
C~RK E R U T COURT
~
I
I FURTHER CERTIFY ihat 1 will oomply with a!I other requirements of a le~al resident of thi: State.
.;:,~~t~ii~~R7HER CERTIFY that I have no intention to retum to my former domiqle, and I intend to remain in FORT
Y -
~;P'1~}~'~:b,~f~j,~f~lE COUNTY, FLORIDA, permanently.
4r•. f~ ~
• , : ` ~ ~ ~
~ ~ ~ ~
. -i r ~ 1 ti 4 ~ ~ = ~ '
~ m~ = rt>. (Name)
` ~ . ; • = Judy C. Woods
J~•
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~~t/ CV :
,•i .~'~s . •
~CrE c'~;
. (Address)
Sworn to and subscribed before me this 23 - day of Sept. ~ 19 66.
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
gy D.C. My Commission expires
(To b~ uc~cuhd in duplicat~ and ori~inal fil~d with C{~elc Grarit Couv?, and dupliut~ with Tax Ass~or.)
gooK155 354
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