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De~lAration ot Domicil• and Cltis.nship 1S~~~
I
~
TO THE STATE AND COUNTY TAX A.SSESSOR, _ ~
Si. LUCIE COU~ITY, FLORIOA:
This is my dccla~ation of Domicife and CitiZenship in ths State of Florida thst I am filinp thi: dsy in sooordanoe snd
in oonformity wlth Ghapter 22Z. Sectio~+ 222.17, florida Statutes.
~ was formerly a legal rosident of 3Drir~g.field YirRinia
~C;y~ (Stat~)
and I ~esided at 6204 Ferrileig~, BOUlevBr~ . However I have charpsd my domidle
(Street and Number)
to and am and hsve been a bona fids resideint of the Stste of Floride sinoe day of
,~9 , and ~ reside at 8ultan Avenus, Port ~t. Zuoie
(Street and Nuanber)
Fort Pierce, ~'lorida
I~ORT r1ERCE, SAINT LUCIE COUNTY. FLORIDA .
, ~
and this statement is to be taken as my declaration of :itizenship, actual legal residenoe and domidle in ths Staro of Horida.
(lnsen he~e any pertinent facts, such as sale of propery or business, or relinqui~ment of employment
.
. at forme~ domicile, removal of family to new domicile, purchsse of home, etc.)
[
A member oi Army and plan to make my
home here when I retire in 1971.
i fILEO AN0 RE6QAp~l1:
sT. LUCIE COUNTY.1~'lA:`~
RECORO YEltIF 0
- ~ 1
'6t JUL i l PM 3: 30
- js~ss~ -
R~GER i'OITR~S
CLERK CIACUIT C8lJR~
I
I FURTHER CERTIFY that I will aompiy with all other requirements of a lepal resldeM of thi: Stste.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, ar~d I intend to remain in- FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~
, (Name)
Zewie Lepper
~;r~:rt•" _
,
- (Address)
~
Swdrn td •{Jric~iubsuibed before me this llth day of a~y 19 67.
- :t ~ , . . j: ~
~n - ' -
~ , ; ROOdE ,~O~S .
` Notary Public
~G°;,:~t`""
gy D.C. My ~ommiuion expires
(To b~ ~x~c~Nd in duplical~ and eri~inal fil~d whh Cls~k qrouit Cove~, and duplic~N wHh Tax At~er.)
a~~~~7 0~~ 4~.4
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