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Decla~ation ot Domicii• and Citizenship
1-51801
TO THE STATE AND COUNTY TAX ASSESSOR,
St. lUC1E COUNTY, FIORIDA:
This is my decla~ation of ~omicile and Citizenship in the State of Ho~ida that 1 am filirp this day in aooordenoe a~d
in oonformiy with Chapter 222, Section 222.17, Floride Statutes.
Washington D~C.
I was formerly a legal ~esident of •
Kiy) (State) ~ -
end 1 msided at _ 3809 ~9th 3t~'eet~ N.~1. . Hcwever 1 have chanqed my domidle
(Street and Number)
ro and am and have been a bona fide resid~t of the State of Florida since 7th ~y ~
January , l9 67 ; and ~ reside at 1706 P'lover Av~s, FbrO Pierce
(Sfroet and Number)
8. Beach
FORT MQC~, SAINT WCIE COUNTY, aoao~
and this statement i: ro be taken as my declaration of citiz~enship, actual le~al residenoe and domitile in the Stsro of Florida.
(Insert he~e any pertinent facts, such as sale of property or business, or ~elinquishment of employmsnt
st former domicile, removal of family to new domicile, purchase of home, etc.)
' F~LEO ANO REGOR p `
ST. ~UCIE COUNTY,~,
RECORD VER~~EO
1518~1
'6~ JAM i l PM 2: I 1
CLERK
CIRCUtT COURT
Establishi g residenae
r
t ~ - '
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1 FURTHER CHtTIFY that I will aomply wHfi all other requirements of a leyal resident of this Stste.
I FURTHER CERTIFY that I have ~o intention to retum to my former domicGle, and 1 intend to remain in fORT
PIERCE, SAINT- lUC1E COUNTY, FLORIDA, permanently.
'~`„i{tsll 117~1, ST'V
~ ' il l;; , • . ~a/?t/~.P/~ .J.
,3:. ' (Name)
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n`' . - . " l~rancis 3. iTeat
's ~ , ~.k; . (/lddress)
~ ~ I , • 1 • r'~
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3vfnorri tq and~wbsuibad before me thi: day of January 19 67
ROGER ~OITRAS ~
CLBK CIRCWT C~ Notary Public
By D.C. My Commiuion expires
(Te b~ ~hd M duplicata a~wl o~inal Al~d wilb Cl~ic Ciraiil Courf, snd d~plieaN wiN~ Tax Aa~.1
a~K ~.64 ~ 456
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