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D~cluation ot Domiail~ aed Citi=e~t~liip _
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TO THE STATE AND COUNTY TAX A?SSESSOR, . ~ -
Sl. lUC1E COUNTY, FIORIDA: ~
This i: my decla~ation of ~omicile and Citiz~r~ship i~ th~ Staro of Florida that 1 ~m filinq this day in sooorda~ and
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in conformity with Chapter 22'l. Settion 222.17, Fiorida StatutK.
i wss forme~ty a leysl resid~nt of Pell~ City Ala - -
(Gty) (St~t~)
and I ro'sided at RLra1 route However 1 hav~ charp~c! my do+nWk
(Stre~t and Numbeir) ~
ro and am and have been a bona fids ~ident of th~ Stst~ of Florida sinoe 3 ~Y ~
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January , 19 61, a,,,~ ~ 113 A2na ~ourt
(Str~t and Numbsr)
fORT I~CE, SAINT WCI! COtINTY. KORIDA
and this stat~ment is ro be taken as my dedsration of citi~nship, actusl l~ai rqtdena and domidle in th~ Stab of Horida.
pnssrt he~e any perti~ent facts, wch ~ sale of propsrty or busineu, or mlinquishm~nt of employm~nt
at former domkile, nrtwval of family to nsw domicils, purchase of har~s, etc.)
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- Applying for homestead and establishing his residence '
FILEO AND R~COADFO
ST. ~CORD VER~iFYIEfI.I?.
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'6T MAR f 4 AM 10 • 5~~~~
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~ ?:O1L'K i•OITR~S
~ C~ERK CIRCUIT COURT
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f FURTHER ~fRTIFY that I will aomply wNfi sll othsr requiremsnri of a lepal r~ideM of this State.
1 FURTHfR CERTIFY that I have no intentlon to r+etum to my former domiGle, and 1 intend to remsin in FORT
PIERCE, SAIt~„~.~~y* 1E~~0UNTY, FLORIDA, permanently.
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. (Name)
- . = ~`i~ , Louis Duck
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L r s~~~~~ Mar_rh 19 67
_~vw~Oth"fd and subsuibed before ms this 14 dey of . -
RO~ rOITRAS - - -
CIRCWT CONRT Notary Public
gy ctc~s.G ~~y%~~ D.C. My ~ommissic~n expires
(Te b~ ~one~Md M d~plieab a~ e~idnal fll~d wilb ClKlc Ciraiif Car~f, aad ddpiiat~ wi1M Tax As~~,?
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