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~ ~eclaration ot Domicile and Citizenship
152356
TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. LUCIE COUNTY, FLORIDA:
This is my declaration of ~omicile and Citizenship in the State of Floride that 1 am fllin9 thia day in aoo~danoe and
~n oonfo~mity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of Desplaines I11_
~C~ty~ (Stat~)
and 1 resided at _ ~091 Algonquin Road . However I have chsn9sd my domWle
(Street and Number) '
to and am and have been a bona fide resident of the State of florida sirxe 30th day of
~ugust _ , ~q 66, and I restde a~ 3072 Treasure Island koad ~
(Stre~t and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actusl legal residenoe end domidle in the State of Horida.
(Insert he~e any peNinent fads, such as sale of property or business, or telinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
Applyi~ng for homestead
FII„ED Akp REC4RDED
,
- sTRECORD
VEVR~ED~~
-~sz~ss ~
~l JAN 31 t : 30
' CL.ERK
jRCU,T R4S
~ COURT
~
1 RJRTHER CERTIFY that 1 will oomply with all other raquirements of a le~al resldent of this State.
.
I FURTHER CERTIF.Y that I have no intention to retum to my former domiGle, and 1 intend to remain in fORT ~
PIERCE, SAl~lj ~VCIE COUNTY, FLORIDA, permanently. _ _ i
;
~ e,n (i _ _ ~ 1
: , ?
' ~y• ~ : : ~ (Nsme)
~ ° ' Howard N. Nelson
V~.~~ J .i'_ 1 i.: ti_ J / ~
'r`: ~ ~ - rL - ~d 7 ~Y ~_.~~.~i.( •
~ • • (Address)
'Cc~
I Sworn.to and subsuibed before me this 31st day of Janaury ~ 1967
ROGER rO1TRAS
CIRCWT COURT Notary Public
g ~ D.C. My ~ommiuion expires
Y ~
~ .
(To b~ uacuhd ie duplicst~ aed ori~inal fil~d wiH~ CIKk GrcuN Cour~, and duplicat~ wilh Tax A~wssor.)
g~~ 164 ~1z~
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