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Oeclaration ot Domicll• and Citizenship ~ .
TO THE STATE ANO COUNTY TAX ASSESSOR, . 1~~~
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S1. WCIE COUNTY, FIORIDA: ~ .
This is my decla~ation o~ Oomicile and Citi=enship in the State of Floricla that 1 am filinq this day in acoorda~ta a~d
in oonformity with Chapte~ 222, Section 222.17, Florida Statutes. '
IlA7~TON . OHIO •
I was formerly a legal ~esids~t of
(city) (St~t.) ~
2238 l~iillox (3rove ~ve.
and I ~esided at ~ . Nowev 1 have chanqed my domitile
(StreeA,and Number)
ro and am and have been a bona fide reside~t of the Stste of Florida since i5th ' day of
Decenber 65 164 Bo~ta Crt.
_ , 19 , and 1 reside at
(Sheet a~d Number)
FORT PI~ICE, SAINT LUCIE COUNTY, FLORI~A
and this statement is to be taken as my declarotion of citizenship, attual IeQal residente and domitile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or busineu, or relinquishment of employment ~
at ~former domicile, removal of family to new domicile, purchase of home, etc.)
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FILING FDR HQrIESTEAD PT)~OSSS
FILEO ANO RECARD~D~
ST. lUC1E COUNT~. FL%~.:
RECORD VERIFIED
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i5i2524 '
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. '6t FE6 - 6 PN 5: O7 ~
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ROGER 'QITRAS ~
CLERK CIRCUlT COURT
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1 FURTHER CERTIFY that 1 will oomply with al) other rsquiremenb of a leyal resident of this State.
I~FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
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~ ED~TIIRD J. BISQi ~
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~ (Address)
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Sworn to and suburibed before me this ~ day of Febr'uary ~~q~.
ROG[~R r0
CLERK IRC URT Notary Public
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gy D.C. My Commission expires ~
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(Te b~ uaarl+d dupliraM aed ori~inal Al~d wilb Cl~k Cirwit ~ov~f, and duplicaN with Tax A~s~sror.)
~ooK164 PAGE1541
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