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~?eclaratio~ ot ~omici~e and Citisenship 152405 ;
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TO THE STATE AN~ COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my detlaration of Oomicile and Citizenship in the State of Florids that 1 am filinQ thi: dsy in saordarxe and
~n owiformity with Chspter 222. Section 222.17, Florida Statutes.
DAYTON ~ OHIO
1 was forme~ly a legat resident of _
- (City) (Staro)
and I ~esided at ~ 2614 G@1108~ St . Flowever 1 have thanyed my domit~le
(Street and Number)
to and am and have been a bona fide ~esident of the Stats of Floreda aince 23th day of
July ~ 66
_ , t9 , and 1 reside at 1310 Baster Ave.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Staro of Ho~ida.
(insert here any pertinent fads, such as sale of properry or buainess, or relinquishment of employment
at former domicile, removsl of family to new domiciie, purchase of home, etc.)
FILING FOR HO.MESTE,AD PURPOSBS _
FILED AND RECOROED
ST. LUCIE COUNTY. RLA.
R~~ORO VERIf1ED
'6T FEB I AM 9: 56
1524Q5
i~O:iE:R POITR~S
CLERK CIRCUtT COURT
,
1 FURTHER CERTIFY that I will comply with all other requirements of a Isqal resident of thls State. ~
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I FURTHER CERTIFY that I have no intention to refurn to my former domicjle, and 1 intend to remain in FORT ~
' PIERCE, SAlNT lUCIE COUNTY, FLORlDA, permanently. ~
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~ ~ L.B~ONARD . CAUL
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`J J.`~~.••: v~.~. (Address)
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' • 1 y February ~ 19 6?
~ r~' SWorh 'to an~ subscribed before me this da of
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^ . ~t IT COURT Notary Public
BY D.C. My ~ommission expires
Ro b~ ~x~cvl~d in duplicab aed o~~nd Rl~d with Clwlc qrcuk Car~f, and dupliuN with Tax A~swr.)
~ ~~~~64 ~i36?.
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