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~acl.aration ot Don~icile and Citizenship !
TO THE STATE AND COUNTY TAX ASSESSOR, 152420 ,
51. LUCIE COUNTY, FIORIDA:
TKis is my declaration of Domicile and Citizenship in the State of Florida that 1 am fili~ this dsy in sooo~danoe and
~n oo~fo~mity with Chapter 222, Sectio~ 222.17, Florida Statutes.
Pout~hkeepsie New York
I was formerly a legal resident of
(Ciy) (Staro)
and I ~esided at 11 Gr ant St reet , However 1 have chanyed my domiCile
(Street and Numbe~)
24th ?
to and am and have been a bona fide resident of the State of Florida since day of ~
Nqvember ,~q 66 and I reside at 4751 SantiaQO Av~. ~ ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, aORIDA ~
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and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Horida. E
Insert here an rtinent facts, such as sale of property or business, or relinquishment of employment ~
( Y Pe I
st former domicile, removal of family to new domicile, purchase of home, etc.) (
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Establishang residence and will apply for homestead
,
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FILEO ANp RECORDED '
. ST. LUCIE COUNTY, ~q,
RECORD VERIF~ED ;
k ~ ~t F j~~~o ~
~ E6 IPN3.28 1
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Roc~ c`~~41~,`
C~ERK C RCUIT COURT
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1 RJRTHER CERTIFY that 1 will oomply with all other requirement: of a lepal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~"~'J(~~%.: • ' s
•.V _
_ ~ ~ r~. . (Nam
= ~ - ~ u • . Frank Mackey
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_ ~ _ ! i:i' , - .
~ ; N.,. ~ = ~ C ~ ~ -
Pauline E(~Mackey
. ,v "GO ~
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.8worn~to end subscribed before me this lst day of February ~ 19 67,
ROGER PORRAS
CIRCUIT C URT Notary Public
~-G n x ires
gy O,.C. • My Comm~uw e p
(To b~ ~x~cut~d in duplicN~ and ori~inal Rl~e! witb C1KIc qrwif Couif, and duplicab wi1l~ Tax A~or.)
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