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De~la~ation of Don~iCile and Citizensh~p
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TO THE ~TATE ANQ COUNTY TAX ASSESSOR,
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1
51. lUC1E COUNTY, FIORIDA:
This is my detlaration of Oomicile and CitiZenship in the State of Flo~ida that 1 am fili~g this day in actordante a~d
~n conformity with Chapte~ ~22, Section 222.17, Florida Statutes. ,
1 was formerly a legal resident of _ BI~IIBFIBI?D ~I. VA.
(City) (Stste)
and 1 resided at 133 Preeton However i have changed my domicile ~
(St~eet and Number)
ro and am and have been a bona fide resident of the State of Florida since lSt day of
April 608 S. 25th 3t.
- . ~q 66 , and 1 reside at
(Street and Number) ;
fORT PIERCE. SAlNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of cititenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
FI~IBG FOR HOMESTBAU PDRP03ES
~?LEO A':C ~ECOR~E A.
ST. LUC1C. COUNT~,F~.
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- 5 ~u'~ 1 ~ ~ ~g
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! FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. i
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t FURTHER CERTIFY that I have no intention to returR to my former domic,ile, and 1 intend to remain in FORT ~'~t
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ~
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, ,a~:tz~,~r~i~,; Mt~S. MAv HARRIS ~
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~,--Swo~n~'~Tip ar~ s~bscrihed before me this 5th day of Deeember ~ 19 6~ ~
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r~! .~RK~~C C T OURT Nofary Pubiit ~
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BY D.C. My Commission expires ~
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(To bs ex~cuted in dvplicats ~n 1 original filed with Clerlc Grcuit Court, and dupliats with Tsx Assessor,) ~
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