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Oe~la~atlon o! Domiclle and Citisenship
- lsi8sa
TO THE STATE AND COUNTY TAX ASSESSOR, _ ~ ~ '
51. LUCIE C4UNTY, fIORIDA: ~ i
, ;
This is my declaration of Domicile and Citizenship in the State of Ftorida that 1 am filin~ this day in aocordante and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal ~esident of K~a•
(City) (State)
and 1 resided at 16 Hoston Stl~eet , Hov,rever 1 have chanqed my domi4le
(Strset and Number) ~
~st
to and am and have been a bona fide re:ident of the Stste of florida since - day of
September ,~9 and I ~eside at 13~ NB~~a Ave. Port St.Lucie
(Sheet and Number)
FORT PIFltCE, SA1NT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicite in tf~e State of Horida. ~
(Inse~t here any pertinent facts, such aa sale of property or buainess, or ~elinquishment of employment
at former domicile, removal of family to ~ew domicile, purthase of home, etc.)
Establishing residence~ ~,.~d.llapp~y for hamestead Y • - - -
FILEO AN~ RECOROED F~~EO AND R ~
ST, LUCIE COUNTY RED ~ ~
ST, LUCIE COUNTY.
RECORO VERIFIED RECORD V~RiF1E0~' ~
1518s0 ~~p .
. ,
'61 JAp 16 AM IO.Oq T FEe : 53
1~~~,~
HO~~R i~O1TftAS - NOGCR ~plTR~g
. C~ERK CIR~V~T ~OUR7 CLERK CIRCUIT COUAT
~
Re-recorded to correct the date of Residence in r'lorida
to read-
November 1~J, 1964
I FURTHER CERTIFY tfist 1 will aomply witfi all other requirements of a te~al resident of this State.
~
• ~
1 FUR~H~R:CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT ~
PIERCE, SAllal~`LUCI~,C¢~P~TY, FLORIDA, permanently., "
: •
_ " ~ .
.:i - _ . , - ~
- . ~ ' • . - ~ (Name
; - ' ' = ~ Regina M. Sa~ndera }
~
~ ~ : , . ~l (Address)
.
Sworn to and subscribed before me this 16~ day of J~~ , ~q 67 ,
- ~
ROGER POITRAS -
CIRCUl~ COUltT Notary Public
~Y ~`'`''~'G ~~~''E~"' D.C. My Commission expires
(To b~ ~x~eul~d in duplieat~ and ori~inal Rl~d witb Cl~ek qrwit Court, aed duptiest~ with Ta;Assuw
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a~164 ~ 589 o R
600K~U~ PACE~~~
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