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Declaratio~ of ~o~ni~il~ ~nd CiUs~nship 15i164 ~
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. IUCIE COUNTY, FlOR10A:
This is my declaratio~ of Oomicile and Citizenship in ths State of Florida thar I sm filiny this day in aa~o?dano~ and
in oonform+ty with Chapter 22Z. Settion 22~.17, FlcKida Statutes.
I was fom~ly a legal msident of ~ng Island NeM YOrk
(City) (Staro)
and 1 resided at 221 Jerusalem Ave. _ , Hov„ever f have chan~ad my domidle -
(Sheet and Number)
to snd am and have been a bona fide resident of the State of Florida since gtb ~Y ~
Au gust 6 6
_ , 19 , and I reside at .~9~ 2000 No. Slst Court
(Street and Number)
FORT MERCE, S/UNT iUC1E COUNTY, FLORIDA
and this state~ent is to be taken as my declarotion of citizenship, athial legal residence and domicile in the State of Fbrida.
(Insert here any pertinent facts, such as sale of propery o~ busine3s, or relinquishmant of employment ~
at former domicile, removal of family to new domicile,. p~irchase of home, etc.) . ' -
Bstablishing residence
~
RILED AND RECQRflgp ~ -
~ ST.~ ~IE COUN'~1r .
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'66 ~ DEC 27 AM i0: 35
---~E~
I
Ct.ERK
CIR U T CBURT
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I
1 RJRTHER CERTIFY that I will aomply with all other requirements of a lepal resident of this State.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domitile, and 1 intend to remain in fORT
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~ PIERCE. SAINj~JUQlfc:l~,Qt~NTIf. FLORIDA, permanentlY-
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.~r •~i.` ~i,G• ~ _ H~1g0 w• ~e ~
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~~~1~n~ Elsie K Fe~ye~s~
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Sworn.to and subscribed before me this 27tb day of December ~~q 66
ROGER PORRAS -
CIRCUR ~ Notary Public
~L~.~G 10 -
~ gy D.C. My Commiuwn expires
(To b~ ex~c~hd in d~plicsh and ori~tnal fil~d wNh Clw~k ~a~f Couet, a~d ~plical~ wi1l~ Tax A~sora
~ 162 ~ 283 -
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