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Declaratioa ot Oomtcile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 1524Qg
ST . WCIE COUNTY, FtOR1~A:
This is my declaration of Oomicile and Citizenship in the State of Florid~ that 1 am filinQ this day i~ sco~rdanos and
in eo~fo~mity with Chapte~ 222, Section 222.17, Florida Statutes.
Louisville Kentucky
I was forme~ty a legal ~esident of
(Ci1y) (Stait)
and I resided at 5210 Bug@t1e . Howsver 1 havs chan~ed my domiCile
- (Stroet and Number)
ro and am and have been a bona fide resident of the State of Florida since - 31 gt dsy ot
Tana>»~~, ~9_~,?and I reside at Causeway T~ai Zor Court ~
(Street and Mumber)
FORT PIERCE, SAlNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decla~ation of citizenship, attual legal residence and domiciis in the State of Horida.
(tnsert here any pertinent facts, such as sale of properfy o? business, or relinquishment af employmeM
at former domiciie, removaf of family to new domicile, purchass of home, etc.)
~ntering children in school
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I fURTHER CERTIFY tF~at I witl oompty wifh all other rsquirameni= of a Ia~al restdent of this Stats. ~
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1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PIER~j' ~:;iiu,.`.
COIINTY, FLORIDA, permanently.
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n: ` - _,r ~;t - Floyd K1~$
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Sworn to and subxribed before me this lst day of February , i967
ROGER POITRAS
CIR~UfT URT Notary Public
BY D.C. My Commiuion expi~es
Ro b~ ~x~cut~d in duplical~ and wi~nal fil~d whb Cl~k Cira~if Court, and duplicab witb T~uc Assa~or.)
so~164 ~~.372
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