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Decla~ation of Domicile and Citize~ship
1490'~'O
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Flo: ida that 1 am fili~g this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ______Sedali8~ !h _ MissOUr~
~C~tyj (State)
and 1 resided at _802_ Ru_ th Antl DriVe _ . However I have changed my domitile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 1$t _ day of
October 66 110 West Prima Vista, Port St. Lucie
_ - 19---, and I reside at -
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNT(, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and clomicile in the State of Ho~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of home, etc.)
ENTHR STUDBNT IN INDIAN RIVER JR. COLLEGB ~
Terrance Lee Feig 1? yrs. ;
i
HOMBSTP,AD PURPOSES
FILED AND RkCORQ~Q
5'T. LUCI~ ~OUNTY P A~ ~
Rf.C~4RD VERIFI~O ~
OCT 10 P~ 1 :37
~ 1490`70 i
~:n.._ ~ ~•ois~cs ~
CLEiiK CIRCUIf COURT I
~
~
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
i n t r turn to m former domi 'le and I intend to remain in FORT ~
I FURTHER CERTIFY that 1 have no intent o o e y u, ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
I ~
~ ~ ~
(Name) J. Feig
110 West Prima Vista Blvd. ~
Port St.Lucie(Address) Ft. Pierce, Fla. ~
i
Sworn to and subscribed before me this, lOth day of October ~ 19 66 _ ~
'''-t ~ ' ~ ~/ii
n ~
ROGER POITRAS J '
~~r'u~- '
: . , • ~
: 4 % i
CLERK CIRC COURT ' V - - ~ c~ ~ Notary Public :
F
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g_ ~ D.C.' ~'V ~ My Commission expires ~
y '~~,d '1.~ 2~ - E
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(To bs executed in duplicsts and wip'tnil fi1e~.with Clerk Gr:uit Court, and dupliute with Tax As~sssor.)
600K 1W PACE J05
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