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Oectarat~on o# Do~icile aad Cit~zens~tip ~
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TO THE STATE AND COUN~Y TAX ASSESSOR, ~ JClt~.~(~
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51. WCIE COUNTY. FLORlDA: f
' m decla~ation of Domicile and Citizenshi in the State of Florida thst I am filing this day in aoco~dance a~d ~
TFus is y P
~n confo?mity with Chapte~ 222, Section 22Z.17, Fiorida Statutes.
ChiCago Ilt
1 was formeriy a iegal res;dent of
. iCity) (State)
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anc! 1 resided at __~_4900 N Marine Dtive Apt ?04_ ~,,,,e„~ ~ have changed my'da~icile
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since --__--._22~d- day of
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, t9~, and 1 ~eside at 2251 No Fedesal Hi-wav RidQecrest Tr. Cr~
- •Street and Number) 1
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FORT PIERCE, SAINT IUCIE COUNTY, FLORIDA ~
and this stateme~t is to be taken as my declarat9on of citizenship, actual legal residence and domiciie in the State of Horide. ~
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(Insert here any pertinent fads, such as sale of prope~ty or business, or relinquishment of employment =
at former domicile, removal of family to new domicile, purchase of home, etcJ '
Bstablishing residence _
AO~tp qE~B: ;
- ST. ~4tlCIE COUNTI'. FLA,-. `
~~CORD VER~F~ED =
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'66 NOV 16 PN 2: SS ~
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- aLERK CIRCUIT COURT
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I FURTHER CERTIFIf that I wiil oomply with ail other requirements of a legal resident of this State. ~
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1 FURTHER CERTIFY that i have no intention to return to my former domicjle, and 1 intend to remain in FORT ~
PIERC~i.SAl1~j,;~tlC)~ ,COUNTY, FLORIDA; ~!!!±anently. ~ ~
. . `J4Y il •~•.f;i/T``, ~
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~ . t Carroll R. . Sutton -
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. ~ s . _ YY~ a,~.~ ~I • ~ ~
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~ . Martha P. utton s
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16th November ~ 19 66 ~
Sworn to and s~buribed before me this day of • ~
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ROGER POITRAS ~
CIRCUIT URT - Notary Public ~
~ ' i n x ires
_ gy D.C. My Commiss o e p
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~ Ro b~ ~xecut~d in dvplicate and ori~ina! filed wit1~ Cl~rk Cjrwit Courf, snd dupliwts with Tax Ass~s~or.)
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