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Declaration ot Domicite and Citisenshfp 15~ ~~t'~~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domiule and Citizensh~p in the State of Florida that 1 am fil~ng this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of t~l'ROR:j, I i. L I\v_; S _ I L L I\'C) IS _
~~;ty~ (State)
and 1 resided at _ 452 SOU_th Un iOn_ S t reet Howeve. 1 have cha~ged my domiC+le :
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(Street and Numbe~) j
anaar 3 1966 }
to and am and have been a bona fide resident of the State of Florida since J _ Y_~_ day of
_january3 _ 6_ 2120 T~arner Road
_ . , 19'~? _ , and I reside at _ _ _ .
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fIORIDA
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and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, pu~chase of home, etc.)
Y.n!~iESTEAD Pt?RPOSES
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~~~~Q ANO REC~OED
3~. lt~C1~ ~O~NXY.
R~CORD V~RiFtEplA. :
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151,~3~ ;
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~ '~5 ~r~° 29 PM 2;~~ i
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' CIERKJER `•0l7Rt.g
F CIRCU?T COURT
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUGE COUNTY, FLORIDA, permanently.
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_ ~ , EL~~E\E A. ISF:ELL (Name)
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2120 Turner Road: Fort Pi~rce Florida
_ " • (Address)
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~ Sworn to and subscribed before me this 29th day of December_____ , 19 6~.
= ROGER POITRAS - - -
CLERK CIRCUIT CO T Nctary Public
gy ~~'-~Zti -r~'s_2~s~ D.C. My Commission expires
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~ (To be executed in duplicate and original fiiled with Clerk Circuit Court, and duplicate with Tax Assessor.) ~
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